VSR-411 (2+2)

General Veterinary Surgery,

Anaesthesiology and Diagnostic Imaging.

SYLLABUS

GENERAL SURGERY- THEORY

Introduction history classification surgical terminology and development of
veterinary surgery.
Asepsis antisepsis, their application in Vety.Surgery.
Surgical Risk & Surgical judgement. Management of shock, haemorrhage &
its management. Principle of fluid therapy in surgical
patients. Differential diagnosis and surgical treatment of abscess, tumors cyst,
haematoma, necrosis, gangrene burn,
wound, classification, symptoms, diagnosis and
treatment & complication ,their treatment and prevention.

PRACTICALS-
Surgical instruments and equipment. Operation theatre routines. Surgical
pack:
Preparation, sterilization and handling. Familiarisation with suture materials,
surgical
knots, suture patterns and their use. Familiarisation to live surgery
haemostatsis.

ANAESTHESIOLOGY- THEORY (Region specific)

Preanaesthetic consideration and preanaesthetics. Aneasthesi, local
analgesia /
anesthesia, general anesthesia, anesthestic agents (like barbiturates,
dissociative
agents) inhalation anaesthesia and agents, maintenance and monitoring of
general
anaesthesia, aneasthestic emergencies and their management. Only
awareness of
neuroleptanalgesia, electro-anesthesia, acupuncture, hypothermia, muscle
relaxants.
Post operative pain management. General principle of chemical restraint of
wild / zoo
animals and aneasthesia, of lab animals.

PRACTICALS-
Familiarisation with aneasthetic, apparatus, endotracheal tubes.
Laryngoscope, gadgets
for monitoring pre aneasthetic preparation, induction of general aneasthesia,
in small
and large animals and endotracheal intubations in dogs. Demonstration of
inhalant
anaesthesia monitoring of general aneasthesia, and the management of
aneasthestic
emergencies. Use of artificial / assisted respiration. Various methods of local
infiltration aneasthesia, and regional block, for surgical procedures of different
regions
of body in Large and small animals. Chemical restraint of lab animals. (Visit of
a wild
animals facility and audiovisual aids)

DIAGNOSTIC IMAGING THEORY

Production and properties of X-rays. Factors influencing production of X-ray.
Principles
of viewing and interpreting X-ray films, classification of radiographic lesions,
Contrast
radiography: classification, materials, uses, indications and contra indications.
Biological effects of radiation, radiation hazards and their prevention by
adoption of
safety measures. Principles of ultrasonography and its applications in
veterinary
practice. Awareness on principles of radiation therapy, Isotopes and their
uses in
diagnosis and therapy; Principles and application of CT scan, MRI,
echocardiography,
scintigraphy, gamma camera, xeroradiography and Doppler.
PRACTICAL-
Familiarization with operation of the X-ray equipment, X-ray accessories and
adoption
of safety measures in radiography. Dark room equipments, X-ray film and its
processing.
Intensifying screen and its uses. Radiographic technique-positioning of small
and large
animals. Handling, viewing and interpretation of X-ray films. Familiarization
with film
contrasts, density and detail, common defects of X-ray films. Radiographic
anatomy and
interpretation of radiographic lesions. Demonstration of contrast technique in
small
animals. Familiarization with ultrasonography of small and large animals

PART- I

(General Veterinary Surgery )

COURSE OVERVIEW

This course is designed to teach students the general veterinary surgery,

general anaesthesia and radiology. The objectives of this course are,

To assist undergraduate students in understanding

o the pathophysiology, differential diagnosis and surgical
treatment thorough knowledge of this subject help the student to
develop the skill to diagnose and perform surgery.
o the various disease conditions are enumerated system wise with
etiology, clinical signs , and diagnostic methods enumerated in a
sequential way.
o monitoring of anaesthesia
o anaesthetic emergencies and their management
o production and properties of X-rays
Illustrations added will aid the student to give quick rememberence of
the disease process.
View vidieo procedures by clicking on the icon.
Applied knowledge of this course information with analytical thinking
will facilitate the understanding of the differential diagnosis.
Overall knowledge gained from this course will help the student to
develop skill ability to approach surgical cases in a systematic manner.
 LEARNING OBJECTIVES

History of surgery
Classification
General surgery principles
Pre and post-operative considerations
History and Development of Veterinary Surgery

Module-1 =

History and Development of Veterinary Surgery

HISTORY OF ANAESTHESIA

300 B.C. Juice of mandrake plant was used during Alexandrian

period. Egyptians induced unconsciousness by compression of the
carotid arteries. In following centuries various plants containing opium
and atropine likecompounds were used.
1540, Paracelsus administered ether to chickens.
1771, Joseph Priestley isolated and identified depholgisticated air-
oxygen and depholgisticated Nitrous oxide.
1825, Hentry Hill Hickman performed surgeries on experimental
animals by inducing asphyxiation using carbon dioxide.
1831, Chloroform was discovered independently by Von Liebig,
Souberian and Guthrie.
1846 William Thomas Green Morton (1819-1868) demonstrated
the use of ether as anaesthetic for the removal of tumor in humans.
Later ether was patented as Lethon. Morton deserves the chief credit for
the introduction of ether as anaesthetic agent.
1846, Chloroform was used first in animals by Flourens.
1847, Horace Wells (1815-1848) though lived only a for short
duration, published valuable information through his news letter A
History of the discovery of the application of Nitrous oxide gas, Ether
and other vapours to surgical operations.
1857, John Snow administered chloroform to Queen Victoria during
the delivery of her eighth son Prince Leopold and later it became
popular.
 Sir William Macewen (1847-1924) Pioneer of oral and nasolaryngeal
intubation in diphtheria patients as an alternative to tracheotomy using
rubber, gum elastic catheters and metal and flexometalic tubes. Later he
administered chloroform and air through the tubes for induction of
anaesthesia.
William Stewart Halsted (1852-1922) Famous surgeon proposed the
Principles of Surgery originated nerve block techniques like blocking
brachial plexus, nerves of the face, internal pudental nerve and posterior
tibital nerve using cocaine in 1886.

Classification of surgery-

DEFINITION

Surgery is a branch of Medicine, in which manipulative and other

modalities are used in treating injuries, deformities and diseases.
The word surgery originated from a Greek word CHEIR meaning
HAND, and ERGON meaning WORK German language it is called
CHIRURGIA.

FUNCTIONS OF A SURGEON

A surgeon mainly deal)s with

o Repair of tissues. Example: Treating a lacerated wound.
o Reconstruction of tissues. Example: Suturing divided tendons and
nerves.
o Control of infection. Example: Post pharyngeal abscess.
o Prevent spread of malignancy. Example: Tumours of lung.
o Alter or correct structural and functional disorders.Example: Correction
of knuckling of fetlocks (Structural disorder).
o Removal of harmful or useless parts. Example:Gangrenous limb,
gangrenous bowel.

REASONS FOR SURGERY

To save life of an animal.

To prolong life of an animal.
To hasten recovery from an injury.
For elimination of disease process. Example: removal of a benign tumour.
For cosmetic reasons.
For correction of deformities.
For replacement of a part by an artificial one.
To make an animal sociality acceptable. Example: Castration in a male cat.
To aid in diagnosis. Example: Exploratory laparotomy.
For investigation in research work. Example: Rumen fistulation.
 OBJECTIVES OF SURGERY

Restoration of functions to as near normalcy as possible.

To eliminate life threating maladies (choke, intestinal obstruction).
Removal of diseased part - gangrenous tail
Removal of foreign bodies - rumenotomy
To hasten recovery process - wounds and fractures
To make the animals to less dangerous - debudding
For economic reasons - e.g.,castration in pigs, cattle etc.,to improve the live
body weight
For aesthetic purposes - removal of supernumerary teat
To replace the organs - Organ transplantation
For confirming diagnosis - exploratory laparotomy .

BASED ON NATURE OF SURGERY

General surgery: Is carried out to restore the normal function of the

body without substituting or discarding any part of the body.
(Restorative Surgery)
Extirpative surgery: Involves removal of a part
e.g.,ovariohysterectomy, eyeball
Plastic surgery: To restore the destructive part which includes
reconstructive surgery (a structure is reconstructed) e.g., skin grafting
and cosmetic surgery (which improves appearance) e.g. docking, ear
cropping etc.
Replacement surgery
Physiological surgery - Portosystemic shunt
Diagnostic surgery
Exploratory surgery

CLASSIFICATION BASED ON REGIONS/SYSTEMS INVOLVED

Specialization on particular system examples

o Thoracic surgery
o Cardiovascular surgery
o Orthopaedic surgery
o Ophthalmic surgery
o Neuro surgery
o Urogenital surgery

CLASSIFICATION BASED ON INSTRUMENT/APPLIANCES USED

General surgery - Is used when in a procedure common surgical

instruments are used
Micro surgery - Magnification facilities are used for specialized surgical
procedures.
 Cryosurgery - Involves controlled use of substances like liquid nitrogen
which produces freezing temperatures to destroyed abnormal tissues.
Electro surgery - Electricity is converted into heat to incise tissue.
Laser surgery - Laser beams are used to cut or destroy diseased tissue
Ultra sonic surgery - High frequency waves are used to destroy
particular tissue or a substance (lithotripsy)
Endoscopic surgery - involves use of rigid and flexible scope e.g.,
laparoscope, arthroscope, bronchoscope

TENETS OF HALSTED

HALSTED described certain essential principles for wound healing. These

include:

Gentle handling of tissues to avoid unnecessary trauma

Aseptic procedures to control infection
Anatomical dissection of tissues with sharp instruments. Avoid damage
to major blood vessels and nerves
Control haemorrhage with fine, non-irritating suture material in small
quantities
Obliteration of dead spaces to avoid accumulation of blood and
exudates which favour pus formation
Use of Minimum suture material
Avoidance of suture Tension
Immobilisation - Give rest to the operated part and to the patient
G A A C O M T I - accronymn

CLASSIFICATION OF PHYSICAL STATUS

It reflects an attempt to define the condition of the animal and thereby

surgeon becomes alert to problems which may occur during anesthesia
and surgery.
Physical status may be of
o Good
o Fair
o Poor
o Extremely poor
o Emergency good
o Emergency poor
o Moribund condition
The patient ->
Identification
History
Preparation of patient .
 IDENTIFICATION

Identification is important due to veterolegal cases

Extension of preoperative medication when owner is not available
To prepare operative site
To avoid chances of wrong animal being operated
To avoid mixing of radiographs

HISTORY

Information provided by the owner may prove highly beneficial since an

animal cannot describe the ailment.
A surgeon should have experience and analytical power to extract
valuable information as an owner may provide misleading history.
A simple language without technical terms should be used while
extracting information.
An approach of through questioning with tact and generation without
irritating the owner may provide better results.
Clinical signs recorded by owner, probable duration of the disease,
status of pregnancy , date of last parturition and status of milk yield
should be recorded.
Information should also be gained regarding the treatment previously
received by the animal
The conflicting points of history should be sorted out logically to gather
reliable information.
Even though history provided by the owner may be useful it is not a
substitute for careful clinical examination.
If history and clinical examination are at variance, it is better to depend
upon the examination.

PREPARATION OF PATIENT

Make the patient an indoor one to accustom with the environment of

ward In ruminants rest for couple of hours lowers the stress(Travel of
animal long distances on feet) Emergency case should be attempted
immediately General physical examinations should be carried to assess
prognosis.
Severe dehydration and debilitation with prominent ribs indicate poor
prognosis if general anaesthesia or major surgery is indicated.
Rough and hard coat .
Sunken eyes
Prolonged lateral recumbency
o Colour of the mucous membrane and capillary refill time are the
o useful aids in dealing seriously ill patients
Rectal temperature, pulse and respirations should be recorded
Palpation, percussion and auscultation help to arrive diagnosis
 In a febrile state surgery should be postponed
Paracentesis of swelling and cavities for differential diagnosis
Laboratory procedures Pathological tests and their correction for
treatment
Radiography
Fluid therapy particularly in case of dehydrated and worm infested
animals.
With holding of feed and water
Large animals: 24 - 48 Hrs ; 12 - 24 hrs
Small animals : 12 Hrs ; 4 - 6 hrs
Administration of laxative, purgative or enema for 2-3 days before
operation to evacuate the bowels and fit for general anesthesia (not
recommended in Ruminants)
Preparation of operation site ->
Day before operation -
Day of operation -
Preparation of the surgeon -
Location -
Planning -
Maintenance of records .

DAY BEFORE OPERATION

Clipping of long hairs by scissors or by shaving the animals. Before

shaving some soapy solution should be used
Washing the area by non-irritant antiseptic lotion like Savlon liquid
Washing by plain water and rubbing gently by cotton or swab gauge
Again washing by running water
Evaporative type of antiseptic wash or lotion should be applied locally
Covering the site by sterile gauge and bandage for the next day of
operation

DAY OF OPERATION

Again wash with antisepti

clotion and shaving
Application of alcohol
At the time of operation the animal should be brought to the operation
table

PREPARATION OF THE SURGEON

Surgeon dresses should be changed in preparation room

 Infection from the nose and mouth should be prevented by using caps
and musk
Shoes of surgical team should be changed
Hands upto elbow should be scrubbed for at least 5 minutes with soap
and running water. Nails should be cut and scrubbed with nail brush or
gauge. Hands should be immersed in cetrimide solution or rinse with
surgical spirit (70% alcohol)
While putting on gloves the outer surface of the gloves should not touch
with the hands .

LOCATION

It is always preferable to do surgery in an operation theater if feasibility

exists where routine professional and manual help in and equally
available.

PLANNING

A surgeon must know the structure to be incised and handled in any

surgical procedure and so be thoroughly familier with surgical anatomy.
If doubt, available literature should be consulted.
Anatomical structure should be reviewed on a cadaver. (Major surgery)
The surgeon should also ensure that the equipments, instruments, drugs
and other items required during an operation have been arranged
properly.
A better approach is to mentally visualize the operation to be done and
make a check list of all items required.
Necessary assistance required for restraint of the animal should be
arranged.
Getting a risk note signed from the owner even for a simple operation is
essential.
A proper planning avoids wastage of time and energy immediately,
before and during surgery.

MAINTENANCE OF RECORDS

A surgeon must keep records of each and every aspects of a case.

The case sheets should be such that there can be stored for future
reference and use.
Description of the patient identification marks, owners name and
address, history of the case clinical findings type of surgical and
postoperative treatment and the outcome should be recorded.
Records can be analyzed to work out incidence of various diseases in an
area and also to judge the efficany of the treatment measures adopted.
Records will help to identity the technical areas of difficulty
Post operative care and management -
 Shifting of patient in the ward
Post-operative medication
Post-operative diet
Post-operative exercise
Post-operative dressing
Release from the ward
Followed by check up

SHIFTING OF PATIENT IN THE WARD

Immediately after major operation, the patient should be gently

removed from operation table.
Unconscious patient should be placed in the bed of surgical ward with
slightly lowered down the head except in brain surgery operation cases.
It prevents cerebral ischemia, vomition and helps to remove
tracheobronchial secretion.

POST-OPERATIVE MEDICATION

According to severity of pain, analgesic drugs should be given to control

pain which may originate from the operation site.
Restlessness can be controlled by the application of sedative or
tranquilizer.
Routine broad or narrow spectrum antibiotic should be given.
Antiemetics may be given to prevent vomition.
Supportive therapy with fluid and vitamins should be resorted too.
o Oral intake of food and fluid is restricted for 12-24 hours after
major operation.
o Liquid diet should be given at second day.
o Semisolid food should be given from forth day.
o Solid food should be given after 8th day of operation.
o Food must be free from fat and some vitamins, enzymes should be
added.

POST-OPERATIVE DIET

Oral intake of food and fluid is restricted for 12-24 hours after major
operation.
Liquid diet should be given at second day.
Semisolid food should be given from forth day.
Solid food should be given after 8th day of operation.
Food must be free from fat and some vitamins, enzymes should be
added.
 POST-OPERATIVE EXCERCISE

Exercise means walking which should be accomplished for 2-3 hours

per day.
The time and distance of walking depend upon the severity of patient.

POST-OPERATIVE DRESSING

Dressing should be done on 3rd, 5th and 7th post-operative days to

visualize the condition of operative site.
The area should be washed with antiseptic lotion and rebandaged for
proper healing.

RELEASE FROM THE WARD

Skin sutures should be removed between 8-10th day of post-operative

days according to the condition.
Operative site should be treated with topical antibiotics and covered by
light bandages.

FOLLOWED BY CHECK UP

The surgeon advised the attendants that the patients must be checked
by him for a certain days.

Module 2 =
ASEPSIS, ANTISEPSIS & THEIR APPLICATIONS IN VETY.
SURGERY.

TERMINOLOGY

Asepsis - being free of disease-producing microorganisms.

Contaminated - dirty, unclean, soiled with germs.
Disinfection - the process of destroying most, but not all, pathogenic
organisms.
Medical Asepsis - the practice used to remove or destroy pathogens
and to prevent their spread from one person or place to another person
or place, clean technique.
Microorganism - a living body so small that it can only be seen with
the aid of a microscope.
Sterilize - to kill all microorganisms including spores.
 Antisepsis: is the destruction of micro organisms but not bacterial
spores on living tissue.
Antibiotic: A substance derived from mould or bacteria that inhibit the
growth of other micro-organisms.
Astringent: Causes contraction of tissues and so arrests haemorrhage.
Styptic: Astringent, haemostatic agent used externally to stop flow of
blood.
Haemostatic: Arresting flow of blood within a vessel.
Sterilization: Complete elimination of microbial viability including
both the vegetative forms of bacteria and spores process by which an
article can be rendered free from all forms of living microbes including
bacteria, fungi and their spores and viruses.

STERILIZATION TECHNIQUES FOR SURGICAL MATERIALS

AND INSTRUMENTS

Two general categories of sterilization methods can be grouped under.

o Physical sterilization
Thermal
Filtration
Radiation
o Chemical sterilization
Germicidal solutions Glutral dehyde, Beta propiolactone
Ethylene oxide

THERMAL

Steam sterilization is the most commonly employed method of

sterilization of instruments and equipment.
Different types of autoclaves are
o pressure steam sterilizer
o steam pressure sterilizer
o vacuum steam sterilizer
o dressing sterilizer
o gravity displacement sterilizer

Points to be considered

Instrument packs are positioned vertically (on edge ) and longitudinally

in autoclave
A 13 minutes sterilizing cycle (exposure to saturated stem at 1210C) is a
safe minimum required
Large linen packs require 30 minutes at 1210C
Once sterilized, sterile packs should be stored in closed cabinets. All
packs should be dated.
 Sharp instruments scissors, needles; surgical instruments can be
sterilized by this method.

Dry heat sterilization

Dry heat destroys microorganisms primarily by oxidation process.

It is used to sterilize those materials for which moist heat cannot be
used either due to deleterious effects on the material or material being
impermeable to steam e.g: oils, powders, glass surgicals etc.
Slow process and long exposure time at a high temperature is required
as spores are relatively resistance to dry heat.

Methods

Direct exposure of instruments to flame not reliable.

Hot air oven most common method.
An exposure to dry heat at a temperature of 1600C for 60 min will
achieve sterilization equal to that of moist heat at 1210C for 15 min, at
151 lbs pressure.

Temperature time combinations for dry heat sterilization

1200c for 8.0 hours

1400c for 2.5 hours
1600c for 60 minutes
1700c for 40 minutes
Exposure time relates to the time after specific temperature has been
achieved and dont include heating lags.
Clean gowns, paper wrapped material, swabs, Petridis 1200c for 8
hours
Stainless steel lens and glass ware 1600c for 60 min

FILTRATION

Filtration is used in air conditioning system to remove particles as small

as 0.3 m in diameter and also used to filter-sterilize heat labile
solutions.

RADIATION

Ultraviolet light is used for surface sterilization.

Ionizing radiations, Beta and cathode rays are used to sterilize heat
sensitive prepackaged surgical materials.
Example: Surgical mask - to produce two fold effect.

CHEMICAL AGENT
 An ideal chemical agent should have following properties
o kill all pathogenic microorganism
o work effectively in short period of time
o exert residual action
o not corrode, dry or stain
o be stable, odorless, non toxic
o be effective in presence of organic matter
o not be inactivated by other concurrently used chemicals

Agents in solution form

Alcohol

Ethyl alcohol (70%), Isopropyl alcohol (90%) are commonly used

Presence of water easily denatures the protein.
o 70% alcohol is more qermicidal than absolute alcohol.
o Isoprophyl alcohol is more bacterial than ethyl alcohol
Sterilization can be done by immensities continuously. Eg: Needles.

Aldehyde

Formaldehyde and flutasaldehyde (cidex, parvo cide )

Formaldehyde

Available as formalin 37% solution of formaldehyde and water.

Used as gas for fumigation.
Irritant to skin and mucous membranes.
o Oxidizing agent e.g. Halogens
Inorganic Iodine compounds
Organic Iodine compounds
o Surfactants Soaps, detergents,
o Phenolic derivatives - carbolic acid

Chemical sterilization by gases

Ethylene oxide acts by inactivating the DNA molecules in the microbial

cells thus preventing cell reproduction. Temperature - 120 to 140F
Eg: ethylene oxide, formal dehyde and beta propiolatone (generally
used)
Sharp edged instruments Scalpel blades, hypodermic needles.

PREOPERATIVE CONSIDERATIONS

A surgeon must keep certain considerations in mind before undertaking

surgery.
 Preoperative considerations may relate to the owner, patient and
Surgeon.

THE OWNER

Owner is the custodian and provider of the animals need and therefore
he has a legal right over his animal.
A veterinarian is legally answerable to the owner.
The owner must be well informed about the diseases, proposed surgical
treatment and the possible outcome.
The owner must be convinced that every thing being done is in the
interest of the animal patient.
Owner patient Surgeon relationship becomes very important in
veterinary profession to maintain a good rapport.
The whole approach towards the owner should be based on the logic and
sound reasoning.
In Eastern countries the relationship may at times be more influenced
by personnel & religious sentiments of the owner, the myths of taboos of
the region.
Incertain instances the owner may strictly forbid the use of a knife or
other cutting instrument on the animal.
A surgeon may be approached for surgery when it is not feasible. Ex.
Multiple fractue of pelvis.
A surgeon must also consider 1. Economic aspects of the case 2. Surgical
risk involved 3.Ethics and centiments of the owner.
After weighing each aspect carefully, the surgeon should make a
decision and communicate the same to the owner in a confident and
convincing tone.
It is the ethical and legal duty of the surgeon to inform the owner about
surgical risk in advance.

SURGICAL RISK

The term risk is used to describe the animals potentiality for surviving
anesthesia and surgery.
To reduce the risk to minimum is of surgeons concern and alert to
problems that may arise during anesthesia and surgery.

FACTORS INFLUENCING SURGICAL RISK

Haemorrage and shock

Fluid and electrolyte imbalances
Acidosis and alkalosis
Anemia and hypovolaemia
Malnutrition and hypoproteinemia
Pulmonary and cardiovascular complication
 Hepatic insufficiency
Renal and adrenal diseases
Obesity of the patient
Extreme of age - complication in both very old and very young animals

HOW SURGICAL RISK IS DETERMINED

Detailed history of animals

Physical status and condition of animal
Individuality
Clinical examination of the patient including general, systemic and
special examination
Essential laboratory examination including routine examination of
stool, urine and blood (clotting time, bleeding time, total count,
differential lecucocytic count, hemoglobin %, packed cell volume)
On the basis of magnitude of operation, nature of aliment with foresaid
findings, the risk of patient is evaluated

ADJUNCTS AND SAFEGAURDS

These are
o Evaluation of operative risk
o Recognition and correction of preoperative deficits
o Prevention of intra-operative and postoperative complication
before they develop
o Resuscitation and after care of surgical patient

SURGICAL JUDGEMENT

Surgical judgment is something that can be developed only over a

period of time, the length of time depending on the surgeons exposure
to many and varied cases.
A Surgeon who continuously makes the same errors can never develop
sound judgment.
When examination and diagnosis favours or indication for surgical
treatment then decision must be made about:
o Feasibility of performing surgery in consideration to the animals
condition.
o When to under take surgery
Feasibility of performing surgery entirely depends of the evaluation of
the patient but the proper timing of operation is more of a problem in
clinical judgment then the decision as to performance.
The decision must be based on the circumstances and the optimum
condition of the patient for surgery.
Such type of decision as to wheather and when to undertake surgery is
applicable both for emergency and elective surgery.
 In elective surgery certain preoperative schedule should be carefully
followed and evaluated.
o Careful recorded history
o Detailed physical examination
o Essential laboratory test
o Radiographic study where necessary
Other diagnostic test like ultrasonography, computed tomography,
doppler study, magnetic resonance imaging etc., wherever required
Emergency surgical operations are those where there is serious injury or
massive internal hemorrhage which may endanger the life of the
patient.
In such cases the preoperative preparation must be limited to be rare
essential.
It is never justified to omit the details of a careful recorded history and
careful physical examination treatment of preoperative preparation of
emergency cases.
Resuscitation, emptying of stomach, empting of bladder by
catheterization should be considered as general rule, if necessary.

Module -3

SHOCK & ITS MANAGEMENT

DEFINITION

A recent veterinary textbook defines shock as "the clinical state resulting

from an inadequate supply of oxygen to the tissues or an inability of the
tissues to properly use oxygen." This deprives the organs and tissues of
oxygen (carried in the blood) and allows the buildup of waste products.
Shock can result in serious damage or even death.
Many attempts have been made to define shock, but because it is such a
complex disorder, no single definition has been successful.

CLASSIFICATION

There are four general categories of shock: hypovolemic, cardiogenic,

septic and vasogenic shock.
 o Hypovolemic shock is the result of inadequate intravascular
circulatory volume commonly resulting from haemorrhage, fluid
loss in excess of intake, or third spacing of body fluids.
A. Acute blood loss: - Major laceration, ruptured abdominal
or thoracic organs, surgical procedures.
B. Fluid loss:- Severe vomiting, diarrhea, burns
C. Fluid sequestration: - Massive tissue trauma, especially
crushing injuries.
o Cardiogenic shock occurs from cardiac insufficiency with lowered
cardiac output.
It may result from:
Inherent heart diseases such as arrhythmias, myocardial
trauma etc.
Extracardiac diseases such as cardiac tamponade, tension
pneumothorax.
The circulatory failure is central in origin.
o Septic or endotoxic shock occurs from massive infection caused
by gram negative microbes. Various diseases which can cause this
type of shock are peritonitis, pyometra, haemorrhagic
gastroenteritis, intestinal strangulation, or volvulus, pericarditis,
mastitis, osteomyelitis etc.
o Vasogenic shock occurs either due to extensive vasoconstriction
or extensive vasodilatation. Direct action of toxic substance on
blood vessels produces dilatation of blood vessels. It leads to
decreased resistance and increased capacity of vascular bed.
Pain or extensive handling and traction of the viscera
massive vasoconstriction
Deep anaesthesia or spinal injury extensive
vasodilatation
Anaphylactic shock occurs due to antigen-antibody
reaction and resultant histamine release. Histamine leads
to increased permeability and massive vasodilatation.

PATHOPHYSIOLOGY OF SHOCK

Although the nature of shock vary, the fundamental sequence of events

is essentially the same in all forms of shock:
o Some precipitating cause decreases cardiac output and blood
pressure
o Stimulation of sympathoadrenal system leads to peripheral
vasoconstriction and shunting of blood away from the skin and
intestinal viscera
o Heart rate and myocardial contractility increases, leading to
cardiac output
o Simultaneously there is increased release of ADH, activation of
rennin-angiotensin system and release of aldosterone which
 ultimately helps to conserve water and sodium through the
kidneys.
In microvascular level certain compensatory changes become less
reversible as shock persists and provide a positive feedback.
o There is lowered oxygen delivery to tissue due to sympathetic
constriction of arteriole and pre-capillary sphincters.
o Development of cellular anoxia with release of lactic acid.
o Permeability of cell membrane increases with release of
lysozymes
o Capillary stasis and decreased capillary pH triggers vascular
pulling and decreased venous return to heart.
o Hypercoagulability also occurs, which may leads to disseminated
intravascular coagulopathy (DIC).
The end result in all forms of shock is cardiac failure ultimately leading
to death. Click here to view the flow diagram of the Pathophysiology of
shock

SYMPTOMS OF SHOCK

It is easy to recognize fully established shock; but it is difficult in early

or compensated shock.
Shock is dynamic and not a static process.
Physical examination findings associated with hypovolemic and
cardiogenic shock include:
o Tachycardia
o Tachypnea
o Pallor of mucous membrane
o Prolongation of the capillary refill time and decrease pulse quality
o Heart murmurs or arrhythmias (not absolute)
Laboratory findings during shock shows lowered red blood cells,
haematocrit and plasma proteins; and elevated blood urea nitrogen
(BUN).
Other signs include weakness, restlessness, and depression, reduced
urine output, coma and dilation of pupils.

TREATMENT

The most important goals in the treatment of shock include:

o quickly diagnosing the patient's state of shock;
o quickly intervening to halt the underlying condition (stopping
bleeding, re-starting the heart, giving antibiotics to combat an
infection, etc.);
o treating the effects of shock (low oxygen, increased acid in the
blood, activation of the blood clotting system);
o and supporting vital functions (blood pressure, urine flow, heart
function).
 Patent airway should be ensured by intubating animal if collapsed or
comatose. Oxygen should be delivered via musk, cannula or
endotracheal tube.
Haemorrhage, if any, should be controlled by direct pressure, bandages,
tourniquet or ligation.
Fluid theraphy: A multi electrolyte, sodium containing crystalloid
replacement solution is usually the fluid of choice; plasma and whole
blood have obvious advantages.

TYPES OF INTRAVENOUS FLUIDS

Crystalloid: Dextrose or electrolyte solutions increase intravascular and

interstitial fluid volume: Isotonic .9% NaCl, lactated Ringers Hypotonic
(5% dextrose in water, 45% NaCl).
Colloids: Do not diffuse easily through capillary walls Fluids stay in
vascular compartment; increase osmotic pressure: albumin, plasma
protein and dextran.
Blood and blood products: Treatment of hemorrhage Restore
coagulation properties.
Glucocorticoid: the role of glucocorticoid in shock state has remained
debatable even in man and small animal. Beneficial effects
(dexamethasone @10mg/kg, prednisolone @ 30mg/kg) include:
increase in cardiac output, decrease in peripheral resistance, increase in
metabolism of lactic acid, improved efficiency of glycolytic enzymes,
stabilization of lysosomal enzymes and interference with endotoxin-
induced immune reaction.
Vasoactive drugs are used to modify sympathetic and adrenal
responses. Dopamine is most popular vasoactive drugs used in shock.
Sodium bicarbonate is indicated to counteract metabolic acidosis
caused by accumulation of lactic acid in shock state.
Broad spectrum antibiotics are indicated to combat wide-ranging
secondary bacterial infection and diuretics for over dehydration or poor
urine output.
Drugs acting on cardiovascular system are also indicated to improve
blood pressure and to stimulate blood flow. Digitalis and adrenaline are
drug of choice in this case.
The animal should be kept in a warm and well ventilated room without
exposing direct heat.
Thrombolytic therapy (drugs that dissolve clots as they form) may be
considered in the case of myocardial infarction or pulmonary embolism.
Treatment with antioxidants that help rid the body of free radicals
(harmful by-products of the oxidative process) may protect against
some types of shock.
o Carnitine may be helpful in treating cardiogenic, septic, and
hypovolemic shock.
o Coenzyme Q10 (CoQ10), an antioxidant, may be beneficial in
treating hypovolemic and septic shock.
 o Glutamine added to parenteral nutrition may protect the
intestines and prevent complications from septic shock.
o N-acetylcysteine (NAC) improved the immune system response in
septic shock caused by endotoxins (toxins released from bacterial
cells).
o Omega-3 fatty acids compared with omega-6 fatty acids may
protect against the harmful effects of septic shock.
o Vitamins B3 and B 12 -nicotinamide (a form of vitamin B3) may
help protect against bacterial endotoxin that causes septic shock.

MODULE-4=

HAEMORRAGE & ITS MANAGEMENT

HAEMORRHAGE

Haemorrhage means escape of blood from an artery, vein or capillary to

extravascular space.
The complete loss of blood is referred to as exsanguination.

CLASSIFICATION

External haemorrhage
Internal haemorrhage
Depending on the time of occurrence
Depending on the source of haemorrhage
o External haemorrhage occurs from open wounds or cut wounds
that is visible on the outside of the body
o Example
Epistaxis bleeding from nose.
Haematuria: Blood in urine.
Haematemesis- vomiting fresh blood .
Haemoptysis coughing up blood from the lungs .
Melena - presence of blood in faeces.
o Internal haemorrhage is bleeding occurring inside the body . It
may be caused by high blood pressure (by causing blood vessel
rupture) or other forms of injury, especially high speed
deceleration occurring during an automobile accident , which can
cause organ rupture. When blood is collected in a newly formed
cavity called as Haematoma.
o Example:
Haemometra - haemorrhage into uterus
Haemopleura - haemorrhage into pleural cavity
Haemoperitoneum - haemorrhage into peritoneal cavity
 Haematocele - haemorrhage in to tunica vaginalis
Haemarthrosis - haemorrhage into a joint
Haematomyelia - haemorrhage into spinal cord
Petechiae - Pinpoint haemorrhages on skin and subcutis
Ecchymosis - haemorrhagic spots on skin and subcutis.
o Depending on the time of occurrence
Primary haemorrhage occurs immediately after injury.
Reactionary haemorrhage occurs within 24hours after the
primary bleeding has been arrested due to mechanical
disturbance of clot in vessel or due to slipping of the
ligature.
Secondary haemorrhage occurs after about a week or more
due to septic disintegration of clot or due to sloughing of
portion of vessel because of a septic or gangrenous lesion.
o Depending on the source of haemorrhage: Arterial, Venous and
Capillary

ETIOLOGY

Trauma - blunt trauma (e.g. fall, motor vehicle accident), laceration, or

penetrating trauma (e.g. knife or gun).
Necrosis and ulcerations of blood vessel wall
Infection and subsequent release of toxins of microorganism
Aneurysm ( weaknesses in blood vessels )
Increased blood pressure
Lack of oxygen and nutrition.
Anaphylactic shock
Deficiencies of coagulation factors.
Deficiency diseases
o Haemophilia
o Thrombocytopenia
o Deficiency of vitamin C, vitamin K
o Plant toxins (sweat Clover)

SYMPTOMS

Bleeding from injured blood vessel

Skin and mucous membrane become pale, cold and moist
Patient feels thirsty
Air hunger
Thready pulse
Hypotension
Low hemoglobin and red blood cells
 HAEMOSTASIS

Haemostasis may be defined as complex interaction between vessels,

platelets, coagulation factors, coagulation inhibitors and fibrinolytic
proteins to maintain the blood within the vascular compartment in a
fluid state.

Methods of haemostasis

Bleeding should be addressed in calm and controlled manner. Gentle

digital pressure on the point of haemorrhage provides an extremely
effective temporary haemostasis in minor bleeding.
Pressure haemostasis: A dressing, typically made of gauze, should be
applied. The tissue should be gently blotted rather than wiped (Wiping
causes abrasion and dislodges blood clots that have formed).
Haemostatic forceps: Crushing of tissues at the point of application
leads to clot formation inside the vessel adjoining the ruptured ends of
the inner coats. This can be done using artery forceps.
Diathermy: Cauterization of vessel is usually performed by Mono polar
coagulation and bipolar coagulation. Arteries less than 1mm and veins
2mm diameter causes vessel wall to shrink and lumen occlude by
thrombosis.
Ligation is the ideal method of controlling bleeding from a vessel which
can be accomplished first by grasping the vessel followed by putting a
ligature. Vascular clips made of titanium or stainless steel is also used
for ligation.
Tourniquet: A cord should be tied around an extremity (limb, tail, penis
etc.) and proximal to bleeding area to control bleeding (not more than
one hour 20 to 60 minutes). The use of a tourniquet is not advised in
most cases, as it can lead to unnecessary necrosis or even loss of a limb.
Topical agents like Fibrin adhesives, oxidized cellulose (regenerated),
absorbable collagen fibrils, and gelatin sponge with or without
thrombus are also helpful for arresting bleeding from small vessels.
Bleeding from drilled cut or chipped edges of bone can be controlled by
using bone wax plugs physically.
Application of Tr. Benzoin, Liq. Ferri perchlor, collodion, ice, cold water
etc. can be successfully used for controlling bleeding from small vessels.
Bleeding from unidentified points of vessels in a wound cavity can be
controlled by packing or plugging the cavity with sterilized gauze pieces
(tampon). Tamponing favours coagulation of blood by exerting pressure
in the area.
Adrenalin, a vasoconstrictor agent when applied topically controls
bleeding especially from a small bleeding vessel.
Administration of vitamin K (Kapillin), calcium and other coagulation
factors may have remarkable effect in controlling haemorrhage.
 Module -5 =

FLUID THERAPY IN SURGICAL PATIENT

FLUID INFUSION

Fluids

Routine administration of multielectrolyte containing crystalloid

replacement solutions at the rate of 10 ml/kg/hr plus 2 to 3 times the
volume of estimated blood loss will satisfy the requirement during
surgery.
During major procedures it can be increased upto 20 ml/kg. Lactated
Ringers is preferred over other solutions during shock.

During anaemia

If the PCV less than 20% blood transfusion is indicated and if the serum
protein is less than 3 to 3.5 g/dl further volume replacement is done
using plasma or synthetic colloidal is administered.
Blood volume is calculated as 8 to 10% of the body weight in dogs (45%
cells and 55% plasma) and 6% in cats(36% cells and 64% plasma).
Blood transfusion is indicated in dogs whose preanaesthetic haemtocrit
is less than 30 to 34% and in cats less than 25 to 29%.
If the blood loss is more than 10% during surgery blood transfusion is
necessary.
Blood and plasma transfusion is done based on the following formula.
o Amount of donor blood needed (ml) = Recipient blood
volume in ml x ((Desired PCV - Patient PCV) / PCV of donar
blood)
o Amount of donor plasma needed (ml) = Recipient plasma
volume in ml x ((Desired TSP - Patient TSP) / TSP of donar
blood)

FLUIDS AND THEIR USE

Isotonic crystalloids

Indications
o To maintain plasma volume in uncomplicated anaesthetized
cases.
o To replace deficits in dehydration
o To restore interstitial fluid status
o To promote diuresis
Disadvantages
o Large volume of administration coupled with migration into
interstitial spaces may result in oedema
o Produce haemodilution in anaemic patients

Hypertonic crystalloids

Indications
o Expansion of plasma volume
o Used in the intial treatment of shock
o Administered intraoperatively during cardiac surgery
o To prevent tissue oedema from the conventional therapy
o These agents increase the plasma volume; cardiac output and
improves the blood pressure. They increase the myocardial
contractility
o Improve the microcirculatory blood flow by decreasing the
systemic vascular resistance, lowering the blood viscosity and
reducing the size of the endothelial cells.
Disadvantages
o Induce hypernatraemia, hyperchloraemia, hypdokalaemia,
hypermolarity and metabolic acidosis
o May induce mild cellular dehydration
o Uncontrolled bleeding will become worsen due to the rapid
increase in blood pressure.

Synthetic colloid solution

Indications
o Hypoproteinemia and hypoalbuminemia
o Blood loss
o Hypovolemia
o Sepsis
o Persistent hypotension
o Does not cross the capillary walls hence will have sustained effect
o No risk of transmission of infectious diseases as compared with
plasma and less expensive
Disadvantages
o Induce pulmonary oedema in patients with permeable capillaries
o May induce circulatory over load
 o May induce coagulation disorders due to dilution of platelets,
precipitation of coagulation factors, increased fibrinolytic activity
and decreased functional von willebrand factor.

Module -6

DIFFERENTIAL DIAGNOSIS & SURGICAL TREATMENT

OF ABSCESS, TUMOUR, CYST , HAEMATOMA=>

ABSCESS -- DEFINITION

Abscesses are circumscribed collections of purulent material (pus) in a cavity,

found in several species of animals in a variety of locations.
This purulent inflammation is usually caused by one of four pyogenic (pus
producing) bacteria: Corynebacterium, Pseudomonas, Streptococcus and
Staphylococcus.

PARTS OF AN ABSCESS

Abscess consists of a wall, pyogenic membrane and pus (Liquor puris).

The pyogenic membrane that lies between the wall and pus, controls spread of
infection, and helps in phagocytosis and granulation tissue formation.

CONTENTS OF PUS AND ITS CHARACTER

Pus contains necrosed tissue, dead bacteria, leukocytes and proteins of blood
and tissues.
Pus cells mainly consist of polymorphonuclear leukocytes along with a few
mononuclear cells.
Pus is alkaline in nature and yellow in colour.
 Pus serum will not clot, since the fibrin of exudates is digested by the
proteolytic enzymes of the leukocytes.

CLASSIFICATION OF ABSCESS

Abscess may be classified as:

o Acute Abscess (Hot abscess): Inflammatory symptoms are more active.
o Chronic Abscess (Cold abscess): Inflammatory symptoms are less
active.
Chronic abscess may be:
Hard with inspissated pus,or
Soft with liquid pus and thin abscess wall.
o Superficial or deep abscess: based on location.

ETIOLOGY OF ABSCESS

Pyogenic organisms like Staphylococci, Streptococci, Escherichia coli and

Pseudomonas aeruginosa.
Specific organisms like Corynebacterium pyogenes, Actinomyces bovis etc.
Chemicals like mercuric chloride and Zinc chloride.

COMMON SEATS OF ABSCESS FORMATION

Cattle: Yoke, udder and prominences

Horses: Shoulders, sub-maxillary and post pharyngeal lymph nodes.
Dogs: Anal region, and mammary glands.

ACUTE ABSCESS

Acute abscess forms in 3 to 5 days following infection.

In long duration abscess, the liquid part is absorbed and the solid part is left.
This is called Inspissated Pus.

Symptoms

Acute superficial abscess appears as a local painful swelling.

The dead tissues and dead inflammatory cells are continuously thrown into the
cavity which leads to a gradual increase in the amount of pus.
Thus the abscess enlarges till it reaches the surface of skin or mucous
membrane.
The center of abscess becomes soft (pointing) and later ruptures, discharging
pus.
Local acute inflammatory symptoms without fever are observed in superficial
abscess.
 Deep abscess has no local symptoms, but fever and pain on manipulation of the
part are evident.

CHRONIC ABSCESS (Cold abscess)

A chronic abscess develops slowly without any inflammatory symptoms.

It may be painless or slightly painful.
Primary chronic abscess usually occurs from repeated injuries and observed on
the prominences of limbs and ribs due to bed sores.
Secondary chronic abscess develops in the course of various local affections.
Chronic abscess may be hard in consistency surrounded by fibrous tissue and
containing small amount of pus or it may be soft and thin walled with
comparatively larger amount of pus.

TREATMENT

Treatment should correspond to the stage of development of an abscess.

In time, abscesses may become inactive or enclosed (sterile); the body defenses
having killed all of the causative bacteria.
The accumulated pus, with no route of escape, will slowly become liquefied
and be absorbed.
o Measures to accelerate maturation of abscess by using liniments,
fomentations and mild blisters.
o Once mature, abscess must be early cleared up of pus by aspiration and
subsequent washing of the purulent cavity.
o The abscess should be opened by symes abscess knife or a scalpel at
the place of pointing. The pus should be drained and the cavity is to be
irrigated with a mild antiseptic lotion. In cases where the pointing of
abscess is not at a dependent Part, then drainage will not be perfect. A
counter opening is made at the most ventral part (dependent Part) of the
abscess.
o Tincture of Iodine soaked gauge is be packed to keep the openings
patent. This should be changed once in 24 hours. The quantity of gauze
used to pack the abscess cavity has to be reduced daily as the cavity is
being filled up by granulation tissue. Gauze soaked with 0.5% silver
nitrate is best against most of the micro-organisms.
o Further therapy is the same as that of a granulating wound.
o A chronic abscess is converted into an acute abscess by applying
blisters, and then treated as acute abscess. Sometimes the chronic
abscess is enucleated under local infiltration analgesia, and the skin is
sutured.
Cellulitis or Phlegmon is diffuse, suppurative spreading inflammation of loose
connective tissue, with predominance of necrotic events over suppurative.
Pustule is a circumscribed cavity with pus, situated in epidermis.
 Furuncle or Boil is suppurative inflammation of hair follicle or a sebaceous
gland due to Staphylococcus aureus. A group of furuncles is called
Furunculosis.
Carbuncle is small boil, which drains to outside by multiple small openings. It
is caused by Streptococci and Staphylococci.
Acne is an abscess of sebaceous gland. It appears as single or multiple pustules
containing grayish white pus. Antiseptic ointments externally and systemic
penicillin gives good relief.
Empyema is collection of pus in a body cavity. Example: Empyema of frontal
sinus, empyema of joint.
Antibioma is a clinical condition resulting from improper treatment of an
abscess.

TUMORS (Neoplasm)

The term neoplasm is a Greek word used primarily for new formations or new
growths.
Tumour may be defined as an abnormal mass of tissue, the growth of which
extends uncontrolled, in comparison to the normal tissue and persists in the
same excess even after cessation of the stimuli which evoked the change.

TYPES OF TUMOR
Benign Malignant
Grow slowly Grow rapidly
Locally grow to great size Create metastases
Dont invade the neighboring tissue Invade and destroy neighboring tissues.
Usually do not return after surgical removal Recurrence after surgical removal

INCIDENCE

Tumors are more common in canines.

o Skin - Common in older dogs (often benign) but much less common in
cats (malignant).
 o Breast - Fifty percent of all breast tumors in dogs and 85% of all breast
tumors in cats are malignant.
o Testicles - Testicular tumors are rare in cats and common in dogs,
especially those with retained testes.
o Bone - Bone tumors are most commonly observed in large breed dogs
and rarely in cats. The most common sites are leg bones, near joints.
o Head and Neck - Cancer of the mouth is common in dogs and less
common in cats. A mass on the gums, bleeding, odor, or difficult eating
are signs to watch for.
Horse and cattle are more often affected than sheep, pig and goat.
o Fibropapillomatosis of the skin, mucosa of mouth, esophagus and
urogenital organs are often seen in domestic animals. Fibroma is more
common in horses, cattle and dogs.
Old animals are affected more commonly than young ones.

VARIETIES OF TUMORS
Tissue of origin Name of tumor Cell type
Mesenchymal Fibroma Fibrous connective
tumors tissue
Chondroma Cartilaginous tissue
Osteoma Bony tissue
Odontoma Tooth substances
Myoma muscular tissue
Myxoma Cardiac skeleton
Lipoma Adipose tissue
Neuroma Nerve cells and fibers
Leiomyoma Smooth muscle
Rhabdomyoma Skeletal tissue
Haemangioma Blood vessels
Meningioma Meninges
Teratoma Germ cells
Epithelial tumors Papilloma Skin or mucous
membrane
Adenoma Glandular epithelium
Basal cell tumour Basal cell of skin
Hepatocellur adenoma Hepatocytes
 Glomus tumour Melanocytes
Blood cells Non-Hodgkin lymphoma and Hodgkin Lymphoid cells
lymphoma
Leukemia Hematopoietic cells

DIAGNOSIS

Clinical examination location, size and consistency

Radiography bones and vascular organs.
Biopsy exploratory cytology

TREATMENT

Prophylactic treatment is undertaken either to reduce the anticipated incidence

rate of a particular tumor type or the rate of recurrence of a neoplastic disease
after therapy.
o Mammary tumors in bitch Spaying between 6 and 12 months of age
will greatly reduce the risk of breast cancer. Surgery is the treatment of
choice for this type of cancer.
o Benign vaginal tumor ovariotomy
o Testicular tumors (Seminoma and sertole cell tumour) - Castration
Definitive excision refers to use of surgery as the sole treatment procedure
without adjunctive radiotherapy or chemotherapy.
o Local excision: The removal of a neoplastic mass with the minimal
amount of surrounding normal tissue.
o Wide local excision: Removal of a significant predetermined margin of
surrounding tissues together with the primary mass.
o Radical local excision: Removes of a tumor with anatomically extensive
margins of tissue extending into fasuil planes which are wndistrubed by
the primary growth of the tumor us termed radical local excision or
compartmental excision. Eg: sarcomas.
Palliative treatment: A procedure that remarkably improves an animals
quality of life by providing pain relief, or relieving poor function, despite the
presence of unsolved systemic neoplastic disease.
o Eg: Limb amputation osteosarcoma
o Spleenectomy Bleeding haemorrhage of sarcoma
 Apart from surgery and chemotherapy, radiation, cryosurgery (freezing),
hyperthermia (heating) or immunotherapy can be effectively used to treat
cancers. Combination therapy is commonly employed.

CYST

A cyst is a closed sac having a distinct inner lining of secreting membrane.

They may contain air, fluids, or semi-solid material.
Cyst may contain a solid structure like tooth (dentigerous cyst) or hair (dermoid
cyst) also.
The outer wall of a cyst is called as capsule.
Most of the cysts are benign in nature, but some may produce symptoms due to
their size and /or location.
Size of a cyst may vary from a small grape to a football.
Cysts can arise anywhere in the body,
o Common example listed below:
Chalazion cyst (eyelid)
Retention Cyst (gland like salivary cyst)
Dentigerous Cyst (associated with the crowns of non-erupted
teeth)
Exudation Cyst (Hydrocoele).
Dermoid (misplaced embryonic tissue).
Encapsulation cyst (around foreign bodies and parasites. Ex:
Cystecercosis)
Neoplastic (Cyst adenoma).
Ganglion cyst (hand/foot joints and tendons)
Glial Cyst (in the brain)
Distension cyst: (Follicular cyst of ovary, cystic distension of a
joint bursa).
Meibomian cyst (eyelid)
Ovarian cyst (ovaries, functional and pathological)
Renal cyst (kidneys)
Sebaceous cyst (sac below skin)

DIAGNOSIS

Cysts are generally non-inflammatory in nature and develop slowly with well
defined periphery.
On palpation fluid filled cyst fluctuates uniformly while cysts with solid mass
fluctuates en-masse.

TREATMENT

Puncture and evacuate the contents of cyst and inject an irritant solution like
Tr. iodine to destroy the smooth lining membrane and setting up inflammation.
Use of setton to drain cyst is a good practice.
 Surgical excision of the cyst is the preferred option. Intact cyst is carefully
dissected and removed from the surrounding tissue in possible cases.

DIFFERENTIAL DIAGNOSIS

An abscess must be differentiated from the following conditions:

Cyst
o Slow in development as compared to an abscess.
o Soft and fluctuates uniformly, but not hard at periphery.
o No inflammatory symptoms.
o No pain sensation.
Haematoma
o Forms due to coagulation of blood or serum.
o Doughy on palpation and forms immediately following an injury.
o Does not point like an abscess.
o No pain sensation.
Hernia
o History of recent injury and swelling.
o Hernial ring can be palpated.
Tumour
o Uniformly hard in consistency.
o Exploratory puncture with needle may reveal blood.
o No pain sensation.
o Does not point like an abscess.

--------------------------------------------------------------------------------------------------------
----

MODULE-7

NECROSIS, GANGRENE & BURNS SCALD.

NECROSIS

Necrosis means death of tissue in the body. This occurs when enough blood is
not supplied to the tissue, whether from injury, radiation, or chemicals.
Necrosis is not reversible.

CLASSIFICATION
 Avascular necrosis is a disease resulting from the temporary or permanent loss
of the blood supply to the bones. Without blood, the bone tissue dies and
causes the bone to collapse. This disease also is known as osteonecrosis,
aseptic necrosis, and ischemic bone necrosis
Coagulative necrosis is typically seen in hypoxic environments (e.g.
myocardial infarction , infarct of the spleen ).
Liquefactive necrosis is usually associated with cellular destruction and pus
formation (e.g. pneumonia ).
Haemorrhagic necrosis is due to blockage of the venous drainage of an organ
or tissue (e.g. in testicular torsion ).
Caseous necrosis is a specific form of coagulation necrosis typically caused by
mycobacteria (e.g. tuberculosis ).
Fatty necrosis results from the action of lipases on fatty tissues (e.g. acute
pancreatitis , mammary tissue necrosis).
Fibrinoid necrosis is caused by immune -mediated vascular damage. It is
marked by deposition of fibrin -like proteinaceous material in arterial walls.

ETIOLOGY

There are many causes of necrosis including injury, infection, cancer,

infarction, toxins and inflammation .
Severe damage to one essential system in the cell leads to secondary damage to
other systems, a so-called "cascade of effects".
Necrosis can arise from lack of proper care to a wound site.
o Physical agents like excessive heat or cold.
o Mechanical injuries that crush or cut off blood supply.
o Loss of blood supply cuts off oxygen may be due to passive hyperemia
with sluggish flow of nutrients and deficient oxygenation (volvulus,
strangulated hernia) and ischemia ( decreased blood supply to a part)
due to thrombus or embolism; compression of an artery, and ergot
poisoning

GANGRENE

Gangrene is necrosis and subsequent decay of body tissues caused by infection

or thrombosis or lack of blood flow.
It is usually the result of critically insufficient blood supply sometimes caused
by injury and subsequent contamination with bacteria. This condition is most
common in the extremities .

ETIOLOGY

The main factors in gangrene are loss of blood supply, and later invasion of the
part by micro-organisms.
Gangrene may be caused by:
o Direct damage to tissues which include:
 Mechanical compression or interference with blood and nerve
supply to a part of the body or an organ while lying on a hard
floor. Example: bed-sores; sit-fast.
Physical agents like application of heat and cold. Example: burns,
frost-bite.
Action of acids, alkali and other chemicals producing dry
gangrene and moist gangrene.
Impaction of intestine in the hernial ring and infestation with
pathogenic microbes especially with anaerobic infection.
o Indirect changes in tissues due to cardiac, venous, arterial or nervous
affections like:
Ergot intoxication, which causes spasmodic narrowing of
arterioles and leads to dry gangrene of extremities. It is
commonly seen in feet of cattle.
Diabetic gangrene narrows arteries and sugar in tissues, favours
bacterial growth.
Senile gangrene i.e. arteriosclerosis in old age, which narrows
lumen of blood vessels.

COMMON SITES OF AFFECTION

Extremities like legs, ears, tail, wattle and combs. It is mostly due to freezing or
ergot poisoning.
Mammary gland: Staphylococcal mastitis produces necrosis due to toxins or
thrombosis of mammary vessels.
Involvement of lung due to wrong drenching of medicines, improper passage of
stomach tube or severe lung infection.
Intestines in equines are commonly involved either with infarction due to
verminous thrombosis of anterior mesenteric artery; or due to acute, local
passive hyperaemia produced by intestinal torsion, volvulus or
intussusceptions.

CLASSIFICATION, ETIOLOGY AND SIGNS OF GANGRENE

Type Etiology Characteristic signs
Wet Sudden interruption of blood flow Affected tissue may
gangrene, or such as due to burns, freezing, injury appear badly bruised,
moist or blood clot. Wet gangrene spreads swollen or blistered.
gangrene very quickly and can be fatal. May also become
infected.
 No clear line between
healthy and affected
tissue.

Dry Insufficient blood flow through the Affected tissue

gangrene arteries such as due to atherosclerosis becomes shriveled,
or blood clots. It usually doesn't dry and blackish or
involve bacterial infection. greenish colour.
cold to touch

Gas Infection with certain types of Swelling around skin

gangrene bacteria, such as clostridium. It due to exudates and
typically occurs at the site of a recent gas formation.
injury or surgery. The bacteria rapidly Skin initially looks
destroy muscle and surrounding tissue. pale and then turns
dark red or purple in
color.
Offensive odour of
exudates.

DIAGNOSIS

Diagnosis of gangrene will be based on a combination of

o History (recent trauma, surgery, cancer, or chronic disease).
o Physical examination
o Results of blood and other laboratory tests (presence and extent of
infection).

TREATMENT

Treatment should be directed to:Prevention of cause and extension of gangrene.

Debridement: Removal of dead, damaged, or infected tissue to improve the

healing potential of the remaining healthy tissue.
Application of warm antiseptic fomentations to relieve pain.
Surgical excision or amputation of a limb or organ.
Antibiotics alone are not effective because they do not penetrate ischemic
muscles sufficiently. However, penicillin is given as an adjuvant treatment to
surgery.
In addition to surgery and antibiotics, hyperbaric oxygen therapy (HBOT) is
used that inhibit the growth and kill the anaerobic organisms.

ULCER
 An ulcer is a localised defect in the continuity of an epithelial surface without
any tendency to heal.
It is usually associated with an inflamed base of granulation tissue with or
without necrotic slough.
The majority is chronically inflamed; the slough at their base represents
inadequate drainage.
Acutely inflamed ulcers may have an outer rim of cellulitis.
Ulcer must be differentiated from erosion which is an epithelial defect with loss
of superficial layers, but the basal layers are intact.

CLASSIFICATION

Iatrogenic ulcers: wound breakdown post-operatively and in irritant fluid

extravasating.
Non-specific ulcers: Ex; Traumatic ulcers including secondary stress ulcers.
Specific ulcers: as observed in tuberculosis, ulcerative lymphangitis, and
glanders.
Malignant ulcers observed in skin and gastrointestinal tract.
Ischemic ulcers or Decubitus ulcers: These are due to continuous pressure
which interferes with supply of nutrition to local tissues leading to pressure or
bed sores.
Infective ulcers: primary e.g. viral, tuberculosis, and secondary e.g. due to
drainage of deep focus.
Neuropathic ulcer e.g. in diabetes

ETIOLOGY

Repeated and continuous irritation of wound. Example: Traumatic ulcer, bed

sore.
Secondary infection of the site by bacteria, fungus or virus with which the
tissues cannot effectively combat.
Insufficiency of nerve and blood supply to the part.
Presence of necrotic tissue or foreign body in a wound.
Specific diseases like tuberculosis, glanders, and ulcerative lymphangitis.
Presence of neoplasm. Example: Rodent ulcer.

COMMON SITES OF ULCERATION

Cattle: yoke
Horse: saddle place, elbow, limbs.
Dog: root of tail, tip of ears, and cornea of eye.

SYMPTOMS

The edge of ulcer may be raised or in level with the surrounding skin and
rugged.
 The center of the lesion may be flat or concave, and may show necrotic spots.
Granulations are pale or blue in colour depending upon the form.
The discharge may be serous, purulent or grayish.

TREATMENT

The specific treatment of an ulcer is dependent on the subtype.

Elimination of the cause adversely affecting the course of ulcerative disease

and stimulation of regenerative processes at the affected site.
Astringent or caustic applications for ulcers with excessive or unhealthy
granulations. E.g. copper sulphate, silver nitrate, carbolic acid.
Thermo-cautery with red hot iron to destroy unhealthy tissue which promotes
granulation and cicatrisation.
Biers hyperaemic treatment.
Antibiotics are only indicated for infected ulcers in which there is evidence of
spread around the margin e.g. a cellulitic rim and there may be ongoing
systemic infection e.g. tuberculosis.
Exposure to ultra violet rays to stimulate circulation and to destroy micro-
organisms.
For large deficits or prolonged ulcers with little evidence of healing, further
surgical intervention may be indicated e.g. skin grafts and rotational flaps.

BURN AND SCALD

Burn is an injury of integuments and underlying tissues, occurring due to high

temperature or chemical substances.
Burn may be defined as tissue changes that occur on excessive absorption of
heat by skin.
Scald is an injury caused by hot liquids or stream.
Scald is likely to be more injurious than because of the hot liquid may penetrate
into the deeper part of tissues.

CLASSIFICATION

According to the depth and severity of burn:

First Degree (Superficial): epidermis is affected and transient erythema,

sometimes vesicle formation and desquamation of the epidermis occurs.
Epidermal burns look red, are painful and heal rapidly.
Second degree burn (partial thickness burn): Here, depth extends to the mid
dermis. Loss of epidermis is complete. Capillaries and venules in the dermis is
dilated, congested and exude plasma. There is erythema, coagulative necrosis
of epidermal cells and vesicle formation. Healing is rapid and complete by the
regeneration of epithelium unless there is involvement of secondary infection.
 Third degree burn (Full thickness): is characterized by coagulation of
epidermis and dermis. Severe edema of the sub cutis develops and dry
gangrene of the damaged tissue occurs. The epidermis is desiccated and
charred with presence of black layer in skin. Permanent scarring occurs due to
healing by granulation. Full thickness burn is insensitive to pain because of
damage of cutaneous nerve endings.
Fourth degree: Here, subcutaneous fascia and deeper tissue like muscles, bones
etc are involved. The clinical features are similar to those described in third
degree burn. Repair is by scar formation preceded by sloughing of the necrotic
tissue.

CAUSES

The following may cause burn:

Thermal injuries
o Direct heat
o Flame
o Scalding
Electrical burns
o Electrical cord exposure
o Lightning

Chemical burns

Injuries caused by chemicals like strong acids and alkalis, solvents, petroleum
distillates and hot tars are referred to as chemical burns.
The chemical produces localized necrosis of skin and deeper tissues with which
it comes in contact.
The degree of tissue destruction depends on the strength of the chemical and
the duration of contact.
Chemical causes local coagulation of proteins and necrosis.

CLINICAL SIGNS

Thermal burns

Superficial-hyperemia, desquamation and pain.

Partial thickness- exudation, pain, decreased sensitivity.
Full thickness- White, black or brown, leathery escher, subcutaneous edema
and little or no pain.

Electrical burns

No pain
 Well-circumscribed cold, blood less, pale yellow lesion.

Chemical burns

Line of demarcation between dead and healthy tissue

Devitalized tissues may get infected
Formation of ulcer which heals gradually

TREATMENT

The therapeutic measures must be aimed at

o termination of painful stimuli and improvement of the nervous system
function for avoiding shock;
o reduction of autointoxication;
o prevention of infection;
o promotion of rejection of coagulated Skin and tissues;
o creation of favorable conditions for regeneration of skin
Anti-shock measures are to be provided to prevent shock that may arise as burn
complication.
Burn may lead to renal failure and fatty infiltration of liver thus appropriate
care should be extended to combat the complication.
Local treatment of burns should include:
o Application of ice (3-17c) pack wrapped in a soft towel and cold water
for 30 minutes or covers it with wet towels. This also helps to remove
caustic substances (acid or alkali) if these are the cause.
o Hair should be removed and gently clean from the site. Necrotic tissue
should be debrided. The area should be swabbed with weak vinegar
(half water, half vinegar) using cotton wool or cloth.
o Topical antibacterial ointments may be applied to prevent the animal
from post burn sepsis. Several topical commercial products like
Aloevera cream, Silver sulphadiazine cream (Indo-Pharma), Silver
nitrate 0.5% Solution, chlorhexidine 0.5% Solution, gentamycin
sulphate 0.1% cream, povidone iodine cream can be used. Soothing and
protective preparations like Badional gel (Bayer), Caladryl cream (Park
Davis), Burnol (Knoll) may be used as burn dressing.
o Drugs like gentian violet, picric acid, acriflavin and tannic acid should
not be used as far as possible as they delay the healing process by
damaging the living cells.
o Analgesic should be given to reduce pain.
o Hypovolemic shock and acidosis are to be prevented by
supplementation of large quantities of fluid (Dextrose 5%) including 4%
sodium bicarbonate.
o The treatment in chemical burns should include washing with lots of
plain water and neutralization of the offending chemicals. Acids can be
neutralized with 2-3% solution of sodium carbonate or milk, while alkali
with 2% vinegar, citric or boric acid. Finally soothing ointment like
 olive oil may be applied. If shock occurs, keep the animal warm with
heating pads or hot water bottles and a blanket of heavy coat. A burn
patient (pet) should be provided with ample warm fluids to drink and
this may be given in the form of milk or glucose water.

FROST BITE

Frost bite is injury of tissues due to the action of a low temperature on them.
The condition is rare in animals because they can withstand cold temperature
due to their hairy coats and will instinctively seek shelter from inclement
weather.
Udder and teats are commonly frozen in cows during exercise on frosty winter
days. Besides the prepuce, penis and scrotum in horses, snout of pig, comb and
wattles of birds, tip of the ear and scrotum of dogs, tail and distal extremities in
other animals are commonly affected.
It usually occurs in a low temperature but it can also ensue in prolonged action
of wet moderate above zero temperature (3-7c) since heat conductance of the
skin is increased and heat emission is intensified by it.

CAUSES

Exposure to cold or chilling environment.

Contact with cold metal, glass, and liquids.
Iatrogenic freezing with cryogens like liquid nitrogen and nitrous oxide etc.

CLASSIFICATION AND PATHOPHYSIOLOGY

Various degrees of frost bite recognized are:

o Mild: contraction of blood vessels (parts appear white) > paralytic
dilatation of blood vessels > engorgement of vessels > parts appear
red and swollen > thawing > severe pain
o Moderately severe: Below 0oC temperature for longer period than mild
> injury of Blood vessels > inflammation of the tissues > redness
of epidermis together with certain amount of necrosis and blister
formation > desquamation
o Severe: Temperature falls for lower than freezing point > impaired
circulation of blood and lymph > parts undergoes necrosis and
gangrene may ensue

CLINICAL SIGNS

Loss of sensation in the affected part.

 Cyanotic or pale appearance of frozen part.
Moderate edemas, pain and very cold to touch.
Shivering.
In neglected cases, necrosis and sloughing of skin.

TREATMENT

Withdrawal from cold

Warming of frost bitten extremities, and restoration of blood and lymph
circulation: Frozen animals must be immediately put in a warm housing to
restore body core temperature. Hot water bag or hot pad may be used for
warming; frozen parts should be bathed in increasingly warm water until pink
colour is restored.

DRUGS

Prevention of infection with systemic antibiotics

Fluid therapy with dextrose should be considered.
Analgesics may be provided to prevent self-trauma.
Artificial respiration should be provided to frozen animals.
The frozen tissue should not be massaged.
Necrosed tissue if there should be removed. Amputation of frozen part if
necessary should be carried out
Diet: High protein, high caloric diet and vitamins should be instituted.

MODULE-8: WOUND

CLASSIFICATION, SYMPTOMS, DIAGNOSIS

AND TREATMENT

Learning objectives

This module deals with

Wound and its classification

Symptoms of wound
Phases of wound healing
Factors affecting wound healing
 INTRODUCTION

A wound is a separation or discontinuity of soft tissues caused by

trauma, surgery or noxious physical agents.

CLASSIFICATION OF WOUND

Open or external wound

There is discontinuity in the skin and other covering tissues to a varying

depth.
In closed or interstitial wound, only deeper tissues, barring the skin or
mucous membrane are damaged.

Closed wound/ internal wound

Contusion is injury to the skin without any break in the continuity of

tissue surface. It is caused by blunt objects and the subcutaneous
tissues, muscles; nerves are damaged to a varying degree.
According to the severity and extent of tissue damage it may be of:
o First degree with rupture of capillary vessels of the skin and
subcutaneous tissue.
o Second degree with rupture of larger vessels leading to
haematoma formation.
o Third degree with major damage of tissues leading to gangrene
formation.

Open wounds

Incised wounds are caused by sharp cutting instruments such as knives,

scalpels, fragments of glass etc with minimum loss to tissue, edges are
regular, bleeds freely and painful.
Lacerated wounds are caused by tearing of tissues with torn and uneven
edges. Wounds have irregular jagged borders and loss of tissue is
limited to skin and subcutaneous tissue e.g.: barbed wire.
Penetrating wounds are types of deep wounds communicating with
cavities like abdomen, thorax, and joints etc. e.g.: stab wounds.
Perforating wound is having two opening, one of entrance and other of
exit.
Punctured wound are caused by sharp pointed objects like nails
relatively with a small opening. There might be presence of infection/
 foreign particles deep into the wound with inadequate opening for
drainage. Ex: Stab wounds.
Gunshot wound is produced by various forms of firearms e.g. injuries
caused by bullet.
Abrasions are superficial damage to the skin, generally not deeper than
the epidermis.
Avulsion occurs when an entire structure or part of it is forcibly pulled
away. Explosions, gunshots, and animal bites may cause avulsions.
Bite wounds are caused by snake; dog or wild animals bite with
significant degree of tissue damage.
Virulent wounds are caused by bacteria or virus leading to formation of
pustules or vesicles e.g.: FMD, anthrax.
Granulating wound is one in which there is a tendency to heal within
expected time.
Aseptic wound is surgical wound made under aseptic conditions where
chances of bacterial contamination are negligible.
Contaminated wound is one where there is presence of micro
organisms.
Infected/ septic wound: A contaminated wound may become infected
after a period of 6 -8 hours where bacterial multiplication may occur
and liberation of their toxin.

SYMPTOMS OF WOUND

Localized pain and bleeding.

Gaping of the lips of wound.
Weakness, paralysis or a loss of function in a dependent portion.
Febrile disturbances in severe septic wound.
Neuritis extending along the course of the nerve involved in the wound.

PHASES OF WOUND HEALING

Wound healing involves a complex series of interactions between

different cell types, cytokine mediators, and the extracellular matrix.
The phases of normal wound healing include hemostasis, inflammation,
proliferation, and remodeling.
Each phase of wound healing is distinct, although the wound healing
process is continuous, with each phase overlapping the next.
Before the advent of modern veterinary practice, many soft tissue
injuries healed with time.
The difference that the modern veterinary practice has made is that the
more severe injuries that would have killed the animal are now
 manageable; the deformity and infection that often accompanies natural
unaided tissue healing can be avoided or minimized.
The Four phases of wound healing are
o Haemostasis
o Inflammatory phase
o Proliferative phase
o Wound remodeling

HAEMOSTASIS

Tissue injury initiates a response that first clears the wound of

devitalized tissue and foreign material, setting the stage for subsequent
tissue healing and regeneration.
The initial vascular response involves a brief and transient period of
vasoconstriction and hemostasis.
A 5-10 minute period of intense vasoconstriction is followed by active
vasodilatation accompanied by an increase in capillary permeability.
Platelets aggregated within a fibrin clot secrete a variety of growth
factors and cytokines that set the stage for an orderly series of events
leading to tissue repair.

INFLAMMATORY PHASE

The second phase of wound healing i.e. the inflammatory phase lasts for
1-3 days in uninfected wounds.
o Classic signs include the following:
Redness (rubor)
Swelling (tumor)
Pain ( dolor)
Heat (calor)
Loss of function (function laesa)
o Process
The inflammatory response increases vascular
permeability, resulting in migration of neutrophils and
monocytes into the surrounding tissue. The neutrophils
engulf debris and microorganisms, providing the first line
of defense against infection. Neutrophil migration ceases
after the first few days post-injury if the wound is not
contaminated. If this acute inflammatory phase persists,
due to wound hypoxia, infection, nutritional deficiencies,
medication use, or other factors related to the patients
 immune response, it can interfere with the late
inflammatory phase.
In the late inflammatory phase, monocytes converted in the
tissue to macrophages, which digest and kill bacterial
pathogens, scavenge tissue debris and destroy remaining
neutrophils. Macrophages begin the transition from wound
inflammation to wound repair by secreting a variety of
chemotactic and growth factors that stimulate cell
migration, proliferation, and formation of the tissue matrix.

PROLIFERATIVE PHASE

The subsequent proliferative phase is dominated by the formation

of granulation tissue and epithelialization.
o Its duration is dependent on the size of the wound.
o Chemotactic and growth factors released from platelets and
macrophages stimulate the migration and activation of wound
fibroblasts that produce a variety of substances essential to
wound repair, including glycosaminoglycans (mainly hyaluronic
acid, chondroitin-4-sulfate, dermatan sulfate, and heparan
sulfate) and collagen.
o These form an amorphous, gel-like connective tissue matrix
necessary for cell migration.
New capillary growth must accompany the advancing fibroblasts into
the wound to provide metabolic needs.
o Collagen synthesis and cross-linkage is responsible for vascular
integrity and strength of new capillary beds.
o Improper cross-linkage of collagen fibers has been responsible for
nonspecific post-operative bleeding in patients with normal
coagulation parameters.
o Early in the proliferation phase fibroblast activity is limited to
cellular replication and migration.
o Around the third day after wounding the growing mass of
fibroblast cells begin to synthesize and secrete measurable
amounts of collagen.
o Collagen levels rise continually for approximately three weeks.
o The amount of collagen secreted during this period determines
the tensile strength of the wound.
 WOUND REMODELING

The final phase of wound healing i.e. remodeling develops 3 weeks

following injury and continues up to two years, achieving 40-70 percent
of the strength of undamaged tissue at four weeks.
This phase is characterized by reorganization of new collagen fibers,
forming a more organized lattice structure that progressively continues
to increase wound tensile strength.
The strength of scar tissue formed in this phase is less than the
surrounding normal tissue.

COMPLICATIONS OF WOUND HEALING

Wound dehiscence is the splitting and separation of previously closed

wound layers. Evisceration is protrusion of viscera through the wound.
Eventration is protrusion of the bowels from the abdomen. The main
causes responsible for these conditions include improper surgical
technique and the local and systemic factors described below.
Dehiscence usually occurs 3-5 days after surgery before collagen
deposition. The characteristics features include incisional swelling,
discolouration, necrosis and unusual exudation.
Haemorrhage due to rupture of blood vessels can lead to development
of hemorrhagic shock and ultimately death.
Traumatic neuralgia is the pain perceived at or around the vicinity of
wound. Primary traumatic neuralgia persist for prolong period whereas
secondary one appear during cicatrisation.
Septicemia and pyemia are the common complications of wound
healing cause by the bacterial toxins due to massive infection and may
lead to endotoxic shock.
Traumatic fever is the resultant of pyrogen release from neutrophils
and injured body tissue.
Haematoma (accumulation of blood in the Subcutis) or seroma
(accumulation of serum in the dead space) may occur due to rupture of
blood vessels following injury.
Sinus (draining tract from a suppurative cavity to the surface) may
develop due to presence of necrotic tissue debris and foreign bodies.
Fistula (abnormal passage between two internal organs) may develop
due to paucity of drainage from a purulent cavity.
Cellulitis is inflammation of the connective tissues presenting as
oedema, redness, pain and heat often with hardness.
Exuberant granulation tissue (proud flesh) is granulation tissue which
grows above the level of the surrounding skin (overgranulation),
preventing epithelial cells from growing across the wound.
 Tetanus may develop due to Clostridium tetani infection particularly in
deep penetrating and punctured wound. Caprine, equine and camalidae
are more susceptible to tetanus.
Adhesions are the major post-operative complication following
abdominal surgery due to rough handling of viscera.
Traumatic emphysema arises due to punctured wounds of the
respiratory or gastrointestinal tract where gas or air accumulate in and
around the wound area.
Venous thrombosis and embolism may occur when fat tissue
accidentally entered in the circulation.
Gas gangrene may develop.

FACTORS AFFECTING WOUND HEALING

Local factors
Systemic factors
Medication
Systemic diseases

LOCAL FACTORS

Good surgical technique is warranted for proper wound healing if

Halsteds principles are followed. The principles include:
o Gentle handling of tissue.
o Aseptic surgical technique
o Perfect hemostasis and preservation of blood supply to the wound
area.
o Close tissue approximation and obliteration of dead space
o Removal of necrotic and devitalized tissue.
Tissue vascularity ensures oxygenation and nutrients which is essential
for wound healing. Oxygen influences angiogenesis, epithelialization
and resistance to infection.
Infection is one of the major factors which retard the wound healing
significantly as it prolongs the inflammatory phase, disrupts the normal
clotting mechanisms, promotes disordered leukocyte function and
ultimately prevents the development of new blood vessels and formation
of granulation tissue.
Topical medications promote wound healing by minimizing bacterial
infection. However, certain antimicrobial agents and local anesthetics
delay the healing process by destroying cellular elements of wound.
Lavage and dressings accelerate wound healing by protecting healing
tissue. Lavage with sterile isotonic solutions like normal saline
decreases the concentration of the microorganisms mechanically and
aids in healing process. Nonadherent, moist dressing triggers
 epithelisation whereas adherent gauge dressing mechanically debride
the contaminated wound.
Presence of foreign bodies such as tissue debris, dirt, soil, sequestrum,
or nonabsorbable braided suture materials delay the healing process by
exacerbating the inflammatory response and inciting infection.
Obliteration of dead space and prevention of fluid accumulation
promote migration of reparative cells and minimizing the risk of
infection during wound healing.
Ionizing radiation retards wound healing by decreasing fibroblast
formation, collagen synthesis and neovascularisation within fortnight of
surgery.
Movement of the wound site prolongs the healing process as movement
can disrupt cell migration, neovascularisation and formation of early
ground substances of the wound.
Mutilation of the wound not only disturbs the healing but also
complicate by creating evisceration like condition.

SYSTEMIC FACTORS

Advanced age retards healing because of reduced skin elasticity and

collagen replacement. The immune system also declines with age
making patients more susceptible to infection. Older animals are also
susceptible to other chronic diseases, which affect their circulation and
oxygenation to the wound bed as compared to young.
Nutrition plays a pivotal role in wound healing process.
Protein is required for all the phases of wound healing, particularly
important for collagen synthesis. Hypoproteinemia slows healing by
decreasing wound tensile strength, delaying fibroplasia and producing
edema.
Glucose balance is essential for wound healing. Hyperglycemia delay
wound healing.
Iron is required to transport oxygen.
Minerals like zinc, copper are important for enzyme systems and
immune systems. Zinc deficiency contributes to delay epithelisation and
disruption in granulation tissue formation by inhibiting fibroblastic
cellular proliferation.
Vitamins A and B complex are responsible for supporting
epithelialization and collagen formation. It is also important for the
inflammatory phase of wound healing.
Vitamin C is essential for formation of intercellular cementing
substances as it is needed for hydroxylation of the lysine and proline
moieties of collagen.
Carbohydrates and fats: These provide the energy required for cell
function. When the patient does not have enough, the body breaks down
protein to meet the energy needs. Fatty acids are essential for wound
healing.
 MEDICATION

Anti-inflammatory, cytotoxic, immunosuppressive and anticoagulant

drugs all reduce healing rates.
o Anti-inflammatory drugs like corticosteroids if used in long term
and at higher doses impair the inflammatory phase, decrease
fibroplasia, collagen synthesis and neovascularisation.
o Chemotherapeutic agents like methotrexate, doxorubicin and
cyclophosphamide delay the wound healing process by inhibiting
cell division or collagen synthesis. In addition, healing process is
adversely affected by depressing immune function,
epithelialization and contraction.
o Anticoagulant drugs retard the healing by interrupting clotting
mechanism and thus making a wound more prone to infection
due to presence of blood clots.
o Most NSAIDs lower resistance to infection and ultimately delay
healing.

SYSTEMIC DISEASES

Systemic diseases like malignancy, uncontrolled diabetes, renal and

hepatic disturbances delay healing process.
A malignancy in the body retards wound healing by altering
metabolism, producing chachexia, and minimizing inflammatory cell
division.
Uremia delays fibroblastic proliferation, granulation tissue formation,
epithelial proliferation and subsequently strength of healing wund.
In patients with uncontrolled diabetes, there is delayed healing as
hyperglycemia impairs collagen formation, neovascularisation,
granulocytes cell functions and ultimately leading to wound dehiscence.

CLINICAL SIGNS OF INFECTION

Local pain/tenderness
Local swelling/oedema
Increased exudate
Frank pus
Wound breakdown
Pyrexia
Delayed healing
Change in appearance of granulation tissue
 Bridging of epithelial tissue
Abnormal smell

MANAGEMENT OF WOUNDS

Humans have always been faced with the dilemma of how to treat
wounds.
Many diverse and interesting approaches to wound management have
been applied throughout medical history. Thirty years ago physicians
believed pus in a wound was laudable and anxiously awaited its arrival;
surgeons today attempt every conceivable means to prevent its
presence.
o Contusions: are treated with cold and astringent applications to
minimize extravasation.
o Haematomas: when small get absorbed other wise they may have
to be opened and treated.
o Open wounds: surgical or aseptic wound, contaminated and
septic wound or infected wounds.

Surgical or aseptic wounds

A surgical wound made with all aseptic precautions in a non infected

tissue is an aseptic wound.
Surgeon should avoid drying of the tissue, excessive trauma and
haemorrhage lower the wound infection.
Prophylaxis against tetanus.
Dependent drainage should be provided if haemotoma or seroma
formation is expected.
Suture should be supported upto healing time 8 -14 days
Systemic use of specific antibiotics as a therapeutic or prophylactic
measure.
Local application of Fly repellents hot summer months.
The patient and the affected injured part should be kept at rest.

Contaminated wound

A fresh wound gets contaminated when it is more than 4 -5 days old.

The principal therapeutic strategies of the open and contaminated
wound are to convert it into a clean closed wound.
 WOUND CLEANSING PROTOCOL

Wound cleansing is a clean - not sterile procedure. Not all wounds

require cleaning.

Reasons to clean a wound

Presence of:
o Foreign bodies
o Debris e.g. slough, residue from hydrocolloid dressings
o Purulent exudate i.e. infection

EQUIPMENT

Clean basin - basin for this purpose must be washed with soapy water,
rinsed and dried before use.
Warm tap water is required otherwise cold water may reduce the
temperature of the wound surface to a degree where cell mitosis will not
recommence for up to 4 hours.
Gauze / soft wash cloth: Contaminated wound, where possible,
immerse and clean. Otherwise, the soaked wash cloth must be squeezed
over it allowing the water to wash over it. Non-fiber shedding gauze
should be used where foreign bodies remain. This is not a routine
practice as it redistributes bacteria, is painful and causes trauma to
healing cells
Disposable gloves (clean but not sterile)
o The following procedures should be meticulously adhered:
A sterile gauze pad should be placed over the wound
followed by shaving the surrounding skin and finally,
cleaning the edges of wound with a detergent soap and
water.
The surrounding area should be draped with a sterile one.
The wound area should be prepared for surgical
debridement by gentle irrigation with lukewarm isotonic
saline solution.
Devitalized and ragged skin edges, nonviable and heavily
contaminated tissues should be removed.
Again the wound area should be exposed by gentle traction
and carefully irrigated.
 After cleansing, dry surrounding skin but not the wound
itself.
The operative field should be again prepared by placing
sterile gauze over the wound and redraping the
surrounding area.
Capillary and venous oozing should be controlled by gentle
pressure and ligating blood vessels if necessary.
Wound closure should be done either by suture without
drainage or placing a small rubber drain into the depths of
the wound and other end in the skin margin.
The wound may be loosely packed with petrolatum-
impregnated gauze and sutured at a later date (delayed
primary closure).

SEPTIC WOUND OR INFECTED WOUND

Basic principles of infected wound treatment strategies

Debridement: Thorough debridement is most essential to manage septic

wounds which will provide easy access to the wound depth.
o All necrotic tissue debris and foreign materials should be removed
until clean, healthy tissue margin of the wound are achieved.
o Infected wound should not be plugged or closed unless infection
is well controlled for primary healing but should be left to heal by
secondary healing.
Lavage: after removal of the necrotic debris, the wound and its
periphery should be copiously irrigated with warm normal saline or
water and soap or 2% hydrogen per oxide.
o Volume and nature of lavage fluid depends on the degree of gross
contamination and size of the wound.
o Addition of antibiotics or antiseptics is not required when large
volume of fluid is used as improper concentrations of such drugs
may have deleterious effect to the wound healing process.
Wound drainage can be achieved by using Penrose drains, plastic or
rubber tubes or open drainage with bandage support. The aim is to
reduce fluid accumulation, dead space, hematoma and seroma. The
following guidelines should be observed:
o Dependent drainage of wound exudate should be provided if
possible so that gravity will aid drainage of the exudate.
o The incision for drainage should be placed in the most direct
route possible and away from anastomotic sites, tendon and
major vessels. They may cause pressure necrosis.
 o Soft, petrolatum based antiseptic gauze should be used to keep
the wound edges apart.
o Incision to place the drain should be made within the zone of
reaction; avoid cutting into non-infected areas. The drain exit site
should be prepared in an aseptic manner and should be covered
with sterile bandages to prevent premature removal or loss of the
drain and to access the nature of the exudate.
o Through and through drainage should not be used.
o Usually drain should be removed after 24-48 hrs. ( insert picture).
Antimicrobial therapy: Selection of the antimicrobial agent should be
based on culture and antibiotic sensitivity test. However, empirical
antimicrobial agents should be advocated in lifethreatening infections
that exists or develops while awaiting culture and sensitivity results (48-
72 hrs). In most cases, animals with existing wound infection are treated
initially with loading dose of intravenous medication. Antimicrobial
therapy should be continued for 10-14 days.
Sterile protective bandaging is a good practice to avoid hospital
infection, colonization of the wound by opportunistic organisms and to
prevent environmental contamination with the infective agent.

PART II ANAESTHESIOLOGY

---------------------------------------------

Module 9

PREANAESTHETIC CONSIDERATION &

PREANESTHETICS-

PREMEDICATION

Premedication and selection of premedicants are important components

of safe anaesthetic protocol in tailoring anaesthetic regimen suitable for
species, breeds, age and disease status.

Aims of premedication

To reduce fear and calm the patient,

To reduce distress during restraining and minor manipulations like
placement of catheters,
To produce pre, intra and post operative analgesia,
To reduce salivary secretion and airway secretion,
To decrease the total quantity or amount of the major anaesthetic drug,
To reduce the delecterious side effects of the major anaesthetic drug,
To provide smooth induction,
To reduce intra operative complications like vomiting and regurgitation
and
 To provide safe and smooth recovery.

CLASSIFICATION OF PREMEDICAMENTS

The premedicants used in veterinary anaesthesia are classified as

follows based on their properties.

S.No. Premedicaments Examples

1 Anticholinergics Atropine sulphate,

Glycopyrrolate

2 Transquilizers or neuroleptics Chlorpromazine,

Acepromazine,
Phenothiazine derivatives trith promaziae
promethorine
Butyrophenones
Droperidol, Azaperone
Benzodiazepines
Diazepam, Medazolam,
Zaazepur clamazolam

3 Sedatives Xylazine,
Detomidine,Meditomedine
Alpha 2 adrenergic agonist
Ranifidiae
Chloral hydrate

4 Opioid agents Morphine, Meperidine

 Agonists Pentazocaine, Butorphenol

Partial Agonists/Antagonists

ANTICHOLINERGICS

Anticholinergic premedicants are atropine sulphate, scopolamine and

glycopyrrolate. Atropine sulphate is a natural product widely available
invarious plants like Atropa belladonna.
It is also found in Jimson weed. Scopolamine is not used in veterinary
practice.
Glylcopyrrolate is a synthetic quaternary ammonium compound.
These agents are competitive of acetylcholine (Ach) hence attenuate the
physiological responses of parasympathetic nerve impules.

CLINICAL PROPERTIES AND USES

These agents are administered to

o suppress the vagal tone
o reduce salivary and bronchial secretions.
Anticholinergic premedication is contraindicated in ruminants as the
salivary and bronchial secretions will become more viscid and block the
airway. They also induce ruminal atony. But their use is justified and
recommended along with anaesthetics and adjuncts, which cause
excessive salivation and bradycardia (eg. Xylazine).
Though the routine use of these drugs has decreased in anaesthetic
protocols, their use is still recommended in patients with preexciting
bradycardia or in combination with drugs anticipated to cause
bradycardia. In animals with preexciting bradycardia they increase the
cardiac out put.
Herbivores are more resistant to anticholinergics.
They increase the heart rate by blocking vagal tone on S.A node. The
increase in heart rate is associated with increased myocardial oxygen
consumption, hence contraindicated in animals with pre exciting
tachycardia, heart failure and cardomyopathies.
Large dose of atropine may cause dilatation of cutaneous vessels due to
the effect on the cholinergic receptors of the vascular smooth muscles
(Atropine flush).
Decrease salivary secretion, gastric acid secretion and gastrointestinal
motility.
 Decrease bronchial secretion, dilate bronchi and increase the pulmonary
dead space.
Induce mydriasis due to the cholinergic blockade of iris and ciliary body
and paralyze accommodation reflex (cycloplegia) resulting in
photophobia and blurred vision.
Indicated in eye surgeries whether performed under local or general
anaesthesia to prevent oculo-cardiac reflex.
Relax the urinary tract smooth muscles and tend to cause urinary
retention.
Excessive dose of atropine and scopolamine may induce hallucination,
excitement and seizures. And this central stimulation is not noticed
after administration of glycopyrrolate, as it does not cross the blood-
brain barrier. Due to this property glycopyrrolate is considered as a
usefulo premedicant in equine anaesthesia.
The undesirable effects of atropine and glycopyrrolate can be reversed
with neostigmine or physostigmine.

ADVANTAGE AND DISADVANTAGES OF ATROPINE AND

GLYCOPYRROLATE-

Drug Advantages Disadvantages

Atropine Less expensive, may induce
sulphate Tachycardia is not extreme variety of cardia
as in glycopyrrolate arrythmias if
Indicated in animals myocardial
requiring immediate oxygen demand is
treatment for bradycardia not satisfied.
due to its quick action. Iduces
bradycardia
initially if
administered
through
intravenous route
due to the
stimulation of
vagal nuclei in the
medulla: hence
intravenous
administration is
contraindicated
for caesarian
 section in bitches.

Glycopyrrolate Less dose (0.44 mg of Not completely effective

atropine is equivalent to in preventing sialorrhea
0.11 mg of glycopyrrolate
in intravenous route).
Controls bradycardia
effectively.
Indicated in caesarian
section as it does not cross
the placental barrier and
causes excessive increase
in the heart rate of
neonates.
Effectively controls gastric
acidic pH and avoids
aspiration of gastric acidic
secretion.
Causes less intestinal stasis
hence indicated in equine
anaesthetic regimen to
reduce the incidences of
post anaesthetic colic due
to ileus.

CLINICAL DOSES
Species Atropine Glycopyrrolate
Horses 0.02 0.05 mg/kg S.C/I.M 0.02 mg/kg S.C/IM
Goats 0.20 mg/kg I.M 0.01 mg/kg I.M
Pigs 0.31.8 mg total dose
0.020.05 mg/kg S.C/I.M 0.010.02 mg/kg S.C/I.M/I.V
Dogs
0.02 0.02 mg/kg I.V
 0.02 0.1 mg/kg S.C/I.V 0.020.02 mg/kg S.C/I.M./I.V
Cats
0.01 0.02 mg/kg I.V
Last modified: Saturday, 9 October 2010, 06:32 AM

PHENOTHIAZINE DERIVATIVES

Phenothiazine derivatives are basically three ring structures in which

two benzene rings are linked by a sulphur and nitrogen atom.
The steriochemical model of phenothiazine derivatives is similar to
epinephrine, norepinephrine and dopamine.
They act on the central nervous system by depressing the brain stem
and connections of the cerebral cortex.
These agents increase the dopamine and norepinephrine turn over in
the brain and block the peripheral actions of catecholamines at alpha 1
receptors.
These agents are weak anticholinergics and have extrapyramidal
stimulating properties.
Acepromazine maleate, triflupromazine hydrochloride, chlorpromazine,
promazine, promethazine and methotrimeprazine are the commonly
used phenothiazines. Among these agents acepromazine,
triflupromazine and chlorpromazine are used in veterinary anaesthesia.

CLINICAL PROPERTIES AND USES

Produce sedation, general calming and reduction in motor activity

Antagonize dopamine excitatory chemoceptors and suppress vomiting.
At high doses and some times in clinical doses induce extrapyramidal
signs such as rigidity, tremors and catalepsy. Hence contraindicated in
patients;
o With the previous history of epilepsy,
o Undergoing myelographic procedures
o With the history of recent intake of organophophorus drugs or
toxicity
Pulmonary functions are maintained following the administration of
phenothiazines except slight depression in respiratory rate
Induce urine production due to the suppression of antidiuretic hormone
Animals undergoing intradermal allergic tests should not be
administered with phenothiazines as they are potent antihistaninics
Depletes catecholamines of the thermoregulatory center and render the
animals body temperature susceptible to the changes in the
environmental temperature.
Tranquilization with phenothiazines is contraindicated in animals
undergoing epidural, spinal or segmental anaesthesia. Following
induction of regional anaesthesia there will be vasodilation in the
anaesthestised part of the body and this effect is compensated by the
vasoconstriction in the unanaesthetized parts of the body to maintain
cardiac out put. This response is abolished by the generalized
vasodilationinduced by phenothiazines.

CLINICAL DOSES
Drug Dose
Acepromazine Dogs = 0.03 0.05 mg/kg I.V, 0.03 0.05 mg/kg
I.M.

Cats = 0.03 0.05 mg/kg I.V, 0.03 0.1 mg/kg

I.M.

Horses = 0.02 0.05 mg/kg I.V, 0.04 0.09

mg/kg I.M.

Cattle = 0.02 0.05 mg/kg i.V, 0.04 0.09

mg/kg I.M.

Pigs = 0.1 mg/kg I.M.

Chlorpromazine Dogs = 0.55 4.4 mg/kg I.V, 1.1 6.6 mg/kg I.M.

Cats = 0.55 4.4 mg/kg I.V, 2.2 6.6 mg/kg I.M

Horses = 1.1 2.2 mg/kg I.M.

Cattle = 0.2 1.1 mg/kg I.V, 0.2 2.2 mg/kg I.M.

Sheep = 0.55 4.4 mg/kg I.V, 2.2 6.6 mg/kg

I.M.

Goats = 0.55 4.4 mg/kg I.V, 2.2 6.6 mg/kg

I.M.

Pigs = 1.0 2.0 mg/kg I.M.

Promazine Horses = 0.44 1.1 mg/kg I.V/I.M.

Cattle = 0.44 1.1 mg/kg I.V/I.M.

 Goats = 0.44 1.1 mg/kg I.V/I.M.

Sheep = 0.44 1.1 mg/kg I.V/I.M.

Pigs = 0.44 1.1 mg/kg I.V, 0.44 4.0 mg/kg I.M.

Triflupromazine Dogs = 1.00 mg/kg

BUTYROPHENONES

Butyrophenones have similar properties like phenothiazines.

They block the central actions of dopamine and norepinephrine.
They are more likely to produce extrapyramidal signs like tremors,
rigidity and catalepsy in clinical doses hence not popular.
Droperidol, fluanisone, azaperone and lenperone are the
butyrophenones used in anaesthesia.
They are potent antiemetics and even prevent drug induced vomiting
produced by opioid analgesics by acting on the chemoemetic trigger
zone. Hence used as neuroleptic analgesics in anaesthetic regimen.
Butyrophenones have less cardiac depressive effects and the
hypotension produced by the agents can easily be reversed with
phenylephrine.
They induce minimal changes in respiratory parameters.

DRUGS AND DOSES

Droperidol
o It is available in combination with an opioid analgesic, fentanyl
citrate. (0.4 mg of fentanyl citrate and 20 mg of droperidol per ml
= Innovar vet) This combination produces profound analgesia for
30 minutes and sedation for a considerable time in dogs.
o In cats it may induce undesirable central nervous system
stimulation.
o Other effects noticed after administration are panting, aggression
upto 48 hours after recovery, defecation and salivation. Naloxone
- 0.04 mg/kg mixed with 4- aminopyridine - 0.5 mg/kg
intravenously reverse the side effects of droperidol-fentanyl
combination.
o Clinical dose
Dogs 0.05 0.1 mg/kg I.M
Cats 0.10 0.11 mg/kg S.C
Pigs 0.10 0.4 mg/kg I.M
Azaperone
o It is widely used in pigs for control and transportation. In pigs it is
administered prior to metomidate. Azaperone sometimes produce
 muscle tremors, sweating and excitement in horses hence it is
unsuitable for equine anaesthesia.
o Clinical dose - Pigs = 0.4 1.2 mg/kg I.M (low dose),2.0 mg/kg
I.M (medium dose), 4.0 mg/kg I.M (high dose)
Fluanisone
o It is available in combination with fentanyl citrate. (0.315 mg of
fentanyl and 10 mg of fluanisone = Hypnorm).
o This combination is contraindicated in patients with respiratory,
renal and hepatic diseases. Naloxone is the reversal agent for this
combination.
o Clinical dose - Dogs = 5 mg/kg along with 0.1 mg/kg of fentanyl
citrate (neuroleptanalgesia).

BENZODIAZEPINES

Benzodiazepines exerts their effects by binding to a specific binding site

on aminobutyric acid (GABA) receptor.
They do not have analgesic property.
These agents are good anxiolytics, hypnotics and anticovulsants.
They have minimal respiratory and cardiovascular depression.
These agents produce muscle relaxation.
Diazepam, midazolam, climazolam and zolazepam are the commonly
used benzodiazepines.
These agents are combined with opioid analgesics and dissociative
anaesthetics.

DIAZEPAM

Diazepam is used to treat status epilepticus in dogs, cats and human.

It can not be used as a sole sedative agent in dogs and cats.
In horses it produces excitation if used as a sole sedative premedicant
hence combined with xylazine.
It decreases the release of catecholamines and act as antidysrhythmic
agent.
It is used as an effective appetite stimulant in dogs and cats at the dose
of 0.05 0.40 mg/kg Oral/I.M.
In human it causes congenital anomalies if administered during the first
trimester of pregnancy. And the significance of this is not clear in
veterinary practice.
It is absorbed by plastic materials hence storage in plastic syringes,
infusion bags and infusion tubes are not advisable.
Rapid intravenous injection may cause thrombosis.
Dose
o Dogs 0.1 0.5 mg/kg I.V, 0.3 0.5 mg/kg I.M.
o Cats 0.05 0.4 mg/kg I.V, 0.3 1.0 mg/kg I.M.
o Horses 0.02 0.04 mg/kg I.V
 o Foals 0.1 0.2 mg/kg I.V
o Cattle 0.1 mg/kg I.V
o Goat 0.1 0.1 mg/kg I.V
o Pigs 1.0 mg/kg I.V

MIDAZOLAM AND CLIMAZOLAM

Midazolam
o It is twice as potent as diazepam.
o Can be administered as premedicant to thiopentone, ketamine
and propofol anaesthesia.
o It is metabolized in the liver rapidly hence less cumulative can be
stored in aquane solution in plastic container upto 100 hours
without loss of potency.
o Dose - Dogs & cats = 0.07 0.22 mg/kg I.M/I.V
Climazolam
o It is a potent benzodiazepine, has variety of use in cattle, sheep,
horses and dogs.
o In horses the drug is combined with other premedicants and
anaesthetics as it may produce excitement and muscle weakness.
o Dose
Dogs = 1.0 1.5 mg/kg in combination with 5.15 mg/kg of
fentanyl I.V
Horses 0.05 0.2 mg/kg I.V
Cattle 0.5 1.1 mg/kg I.M
Sheep & goats 0.5 1.1 mg/kg I.M
Pigs 0.5 1.0 mg/kg I.M
Chicken 5.5 11.0 mg/kg I.M

ZOLAZEPAM AND FLUMAZENIL

Zolazepam
o It is marketed in combination with dissociative drugs like
tiletamine (250 mgs of tiletamine and250 mgs of zolazepam in
lyophilized form). For dose calculation the two drugs are
considered as one product (500 mg).
o Dose
Dogs 6.6 - 9.9 mg/kg I.M, 2.0 - 43 mg/kg I.V
Cats 6.0 - 11.9 mg/kg.I.M.
Flumazenil
 o The actions of all benzodiazepines can be reversed or antagonized
with flumazenil at the dose of 0.1 mg/kg I.V.

ALPHA 2 ADRENERGIC AGONIST

Alpha 2 adrenergic agonists are referred as sedative analgesics.

The popular agents are xylazine hydrochloride, detomidine,
meditomidine and romifidine.

XYLAZINE HYDROCHLORIDE

Xylazine is a sedative analgestic having alpha 2 adrenergic agonist

activity.
It produces dose-related depression of the central nervous system.
The duration of analgesic activity is 15 30 minutes and the sedation is
for 1-2 hours.
Ruminants are more sensitive to xylazine. One tenth of the dose used in
horses and dogs induce sedation and recumbency in cattle.
In horses it is a reliable sedative and the horse will be in standing
position in clinical doses. Drooping of head and buckling of hind limbs
are commonly noticed in horses. The clinical dose through intravenous
route is 1.1 mg/kg. Further increase in the dose will not increase the
intensity of sedation, only the duration will be increased.
Emesis is common in dogs and cats after xylazine injection due to the
stimulation of central emetic center.
Produces muscle relaxation, which is attributed to decrease in
intraneural and synaptic transmission in the central nervous system.
Xylazine is used in the treatment of equine colic for pain relief. But it
must be used with caution as it may mask the clinical signs and may
aggravate ileus.
Xylazine induce profound depression of cardiovascular system.
Bradycardia, decreased cardiac out put, hypotension and and increase
in central venous pressure are noticed. It also often produces A.V block.
Intravenous administration causes a transient increase in blood
pressure. Administration of anticholinergies as premedicants reduce the
incidence of bradycardia and even the bradycardia that occurs after
administration of xylazine can be reversed with atropine (0.045 mg/kg
initially and followed by 0.01 mg/kg intravenously).
It is contraindicated in branchycephalic breeds, older dogs and in
intestinal obstruction.
 It increases the sensitivity of myocardium to the circulating
catecholamines. Cardiac dysrhythmias may occur if used along with
halothane.
In ruminants it reduces the gastrointestinal and ruminal motility with
relaxation of cardia oesophageal sphincter. This favors ruminal tympany
and regurgitation.
Xylazine has oxytocic property and increase the intrauterine pressure
hence it may induce abortion in pregnant animals. Increase in
intrauterine pressure may cause embryo/ovum ejection if administered
in embryo/ovum transplantation.
Thermoregulation is depressed following xylazine administration and
the animal may become hypothermic or hyperthermic depending on the
ambient temperature.
Xylazine is used as epidural anaesthetic because of the presence of alpha
receptors in the spinal cord and its structural similarity with lidocaine.
Other effects
o Excessive urine production because of the suppression of
antidiuretic hormone
o Salivation
o Hyperglycemia
Dose
o Horse 1.1 mg/kg I.V/IM
o Dogs & cats 0.2 --- 1.1 mg/kg I.V/I.M/.S.C
o Cattle, sheep & goats
0.05 0.08 mg/kg I.M. standing restraint
0.1 0.3 mg/kg I.M. recumbency and prolonged
0.1 0.2 mg/kg I.V recumbency
o Pigs
1.0 2.0 mg/kg I.V
Upto 4.0 mg/kg I.M.
o Epidural 0.07 0.17 mg/kg in 5.0 to 10.0 ml of saline

OTHER AGENTS

Detomidine

Detomidine is a potent alpha 2-adrenaergic agonist mainly used in

horses and cattle.
Advantages of these drugs
o Does not stimulate pituitary adrenocortical adrenocortical axis
hence stress is less.
o Can be administered in pregnant animals
o Can be administered in animals which are not fasted
o It is very effective in relieving pain from colic in horses.
o Provides standing restrain in cattle at the dose of 10 to 20 g/kg
I.V
 o Dose (not recommended in dogs cats and wild felines): Horse,
Cattle, Sheep & Goats 10 - 40 g/kg I.V

Meditomidine

It is a potent alpha 2 adrenergic agonist used in small animal

anaesthesia. The other properties are similar to xylazine.
Dose
o Dogs 0.01 - 0.04 mg/kg I.V/I.M/S.C
o Cats 0.04 - 0.08 mg/kg I.V/I.M/S.C
o Cattle 0.01 - 0.02 mg/kg I.V

Romifidine (Sedivet)

It is developed from clonidine and has alpha 2 adrenergic agonistic

action. Used in horses and maximum sedation is achieved at the dose of
80 g/kg I.V

SPECIFIC REVERSAL AGENTS

Alpha 2 antagonists -

Yohimbine hydrochloride
o It is a specific reversal agent for xylazine and detomidine.
o It is an alpha 2 adrenergic blocking agent used at the dose of 0.1
mg/kg I.V.
o It is often combined with 4-aminopyridine (0.04 mg/kg) for
better results.
o Yohimbine is used in the treatment of equine colic due to ileus.
o It reverses the gastrointestinal stasis produced by xylazine.
Atipamezole
o It is used to reverse the effects of meditomidine at the dose of
0.04 0.5 mg/kg I.V.
Doxapram
o It is not a specific reversal agent to alpha 2 adrenergic agonists
but offer certain beneficial effects due to its central nervous
system stimulation and respiratory stimulation.

CHLORAL HYDRATE

Chloral hydrate is used as a reliable sedative hypnotic in cattle and

horses.
It is less expensive and still perfectly acceptable sedative agent.
It has deeply penetrating aromatic odour and is bitter in taste.
The central nervous system depression is due to its metabolic product
namely 2,2,2 trichloro ethanol, hence the sedative effect is prolonged
even after cessation of administration.
 It does not have analgesic property.
Trichloro ethanol conjucates with glucuronic acid to urochloralic acid
and excreted.
Chloral hydrate depresses the motor and sensory responses at sedative
dose and produces cerebral and medullary center depression at
anaesthetic dose resulting in muscle relaxation and depression of
cardiac and respiratory system.
In cattle it can be drenched preferably through stomach tube, at the
dose of 30 to 120 grams dissolved as 1 in 20 solution in water.
Bullls that are uncontrollable and free in the yard can be controlled by
water deprivation for brief period and allowing them to drink chloral
hydrate dissolved water (90 to 120 grams in 12 litres of water).
Chloral hydrate is administered as 10% solution intravenously in cattle
at the dose of 80 to 90 mg/kg.
Chloral hydrate is combined with magnesium sulphate at 2:1 or 3:1 ratio
(weight) and administered in cattle.
It is combined with magnesium sulphate and pentobarbital and
administered to horses (Equithesin mixture).
Intravenous dose of chloral hydrate in horses
o Chloral hydrate alone 5 to 10 mg/kg for mild sedation and
hypnosis, 20 to 40 mg/kg for moderate sedation and hypnosis, 50
to 75 mg/kg for profound sedation and hypnosis and 150 to 250
mg/kg for anaesthesia.
o Chloral hydrate 100 mg/kg and thiopentone 1.5 to 2 mg/kg
o Chloral hydrate 100 mg/kg and ketamine 1.5 to 2 mg/kg
o Promazine 0.6 to 0.8 mg/kg, 7% chloral hydrate 20 to 40 mg/kg
and thiopentone 5 to 7 mg/kg
o Acepromazine 0.04 to 0.08 mg/kg, 7% chloral hydrate 20 to 40
mg/kg and thiamylal 2 to 4 mg/kg.
o Xylazine 0.4 to 0.6 mg/kg, 7% chloral hydrate 20 to 40 mg/kg
and thiamylal 1 to 2 mg/kg.
Disadvantages of chloral hydrate
o Prolonged hangover with ataxia and stupor
o Perivascular administration causes pain, swelling and necrosis
o Induces abortion in mares

Opioids Derivatives -

Pure agonists-

Morphine

Pathadine,meperidine and oxymorphone -

Fentanyl citrate and etorphine -



Partial agonists -

Partial agonists (agonists/antagonistics)

Pure Antagonist

PURE AGONISTS - MORPHINE

Morphine
o Morphine is derived from the dried milky exudates of the unripe seed
capsules of the opium poppy (Papaver somniferum).
o The exudates contains 3-25% of morphine, 5% noscapine and 0.8%
papaverine.
o The laboratory synthesis of morphine is different hence still it is derived
from opium poppy. The laboratory synthetic agents are codeine, heroin
(dimorphine = diacetylmorphine) and oxymorphine.
o Morphine acts and produces
Analgesia
Drowsiness
Produce nausea and vomiting by stimulating chemoceptor trigger
zone for vomiting. It induces dopaminergic excitement in cats,
horses, pigs, dogs and cattle.
Induce respiratory depression
Depress cough
The effects on myocardium are not significant; but produce
increase in vagal tone and slowing of heart.
Morphine is used as a postoperative analgesic for pain relief in
veterinary practice.
Morphine decreases motility of stomach with increase of antral
portion. Initial use may cause defecation and chronic use will
result in constipation.
It is absorbed from the gut and oral mucosa.
It is used in the treatment of congestive heart failure to relieve
pain and decrease after load.
Preservative free morphine can be administered epidurally to
relieve pain.
Dose
o Horses Morphine gives good results in horses if administered after
xylazine sedation. Xylazine 1.0 mg/kg I.V and morphine 0.6 mg/kg I.V
o Dogs 0.2 0.5 mg/kg ( total dose not exceeding 10 mg ) I.M/I.V
o Cats 0.05 0.1 mg/kg S.C/I.M. must be administered with caution
because it may induce CNS stimulation. Hence must be used with
suitable tranquilizer.
 o Morphine is administered after administration of Acepromazine.
Acepromazine 0.1 mg/kg I.M. and Morphine 0.6 mg/kg I.M.

PATHADINE, MEPERIDINE AND OXYMORPHONE

Pathadine
o Pathadine is a vagolytic and negative inotropic drug at clinical doses.
o It reduces salivation and respiratory secretion without inducing vomiting
and defecation.
o Pathadine induces histamine release if administered through intravenous
route.
o Dose
Dogs = 2 - 6.5 mg/kg S.C/I.M
Catls = 2 - 4.4 mg/kg S.C/I.M
Meperidine
o It is a synthetic product, less potent (one tenth of morphine) and used in
dogs and cats.
o Intravenous administration causes release of histamine hence most often
used along with acepromazine. (Phenothiazines are potent
antihistaminics)
o Dose: Dogs and Cats 2-5 mg/kg I.M
Oxymorphone
o Oxymorphone is a synthetic derivative having 10 times greater potency
than morphine.
o It is widely used in dogs and cats for its analgesic property. Analgesia
lasts for 4 hours.
o It does not cause histamine release as meperidine.
o It is used popularly in small animal anaesthesia due to its analgesic and
lack of release of histamine.
o The only limitation with drug is stimulation of vagus leading to
bradyarrhythmias and it can be reduced or prevented with the use of
antichlinergic agents in the protocol.
o It is also administered epiduraly to control pain in the hindquarters
(0.025 - 0.05 mg/kg).
o Dose
Dogs 0.05 - 0.2 mg/kg I.V/I.M/S.C (total dose not exceeding 4.5
mg)
Cats 0.05 - 0.4 mg/kg I.V/I.M/S.C
Horses 0.02 - 0.03 mg/kg I.V/I.M.

FENTANYL CITRATE AND ETORPHINE

Fentanyl citrate

Fentanyl is a synthetic opioid product related to phenylpiperidines.

Its analgesic property is 80 times greater than morphine.
 Cardiac out put, heart rate, respiratory rate and arterial oxygen tension (PaO2)
are reduced following administration of fentanyl.
Fentanyl citrate is available alone, or in combination with droperidol
(Innovar vet contains 0.4 mg of fentanyl and 20 mg of droperidol per milliliter)
or fluanisone. (Hypnorm contains 0.315 mg of fentanyl and 10 mg of
fluanisone per milliliter) Fentanyl combinations provides good intra operative
analgesia.
In dogs and primates it produces sedation and myosis whereas in horses it
produces excitement and mydriasis. It is not recommended in cats.
Dose - Dogs 0.01 - 0.02 mg/kg I.M/I.V. (see butyrophenones for other doses).
The other synthetic pure agonists are afentanil, sufentanil, lofentanil and
carfentanil.

Etorphine

Etorphine is a potent synthetic morphine derivative. Its general properties are

similar to morphine.
The dose of etorphine is 0.5 mg/500 g B.W
Etorphine is an extremely long acting agent whose effects are maintained by
enterohepatic recycling.
The action of this drug can only be terminated by the administration of the
specific antagonist Diprenorphine.
In clinical dose etorphine along may produce initial excitement hence it is
marketed in combination with phenothiazine derivatives. Separate
combinations are available for large and small animals. Each pack of the
marketed drug will be having two components. 1-Immobilon and 2-Revivon.
Preparation
Immobilon L A contains Etorphine 2.45 mg/ml and acepromazine 10 mg/ml
Immobilon S A contains Etorphine 0.074 mg/ml and Methotrimeprazine 18
mg/ml
Revivon L A contains Diprenorphine 3.0 mg/ml
Revivon S A contains Diprenorphine 0.272 mg/ml
This mixture is popularly used to capture elephants and giraffes
Not recommended for domesticated and wild felines
Etorphine is extremely potent in human and any accidental injection may cause
death if not treated with naloxone or diprenorphine.

PENTAZOCAINE, BUTORPHENOL TARTRATE AND BUPRENORPHINE

Pentazocaine

It is used as an analgesic.
In human it causes dysphoria and hallucination and pentazocaine is developed
to prevent drug abuse.
In clinical doses it produces pulmonary vascular resistance.
 In horses it is used in the treatment of colic and administered at the rate of 0.33
mg/kg I.V.
Dose -3 mg/kg for 1 to 3 hours of analgesia.
Penlog -Duration of analgesia 3-4 hour .
Onset 1 min one hour

Butorphenol tartrate

Butorphenol is used in horses, cats and dogs.

It produces sedation, analgesia and increase in pulmonary vascular resistance.
Dose
o Horse = 0.1 mg/kg I.V
o Dogs = 0.2 0.8 mg/kg I.M/S.C
o Cats = 0.2 0.4 mg/kg I.V/I.M/S.C
o Onset 1 mint 15 mint I.V. rapid

Buprenorphine

Respiratory depression is more and often treated with intermittent positive

pressure ventilation.
Dose
o Horses = 6 - 10 g/kg
o Dogs = 0.01 - 0.02 mg/kg S.C/I.M/I.V
o Cats = 0.005 - 0.02 mg/kg S.C/I.M

PURE ANTAGONISTS

Naloxone hydrochloride, nalorphine hydrochloride and diprenoorphine are the

opioid pure antagonists used for the reversal of the effects of pure agonists and
partial agonists.
In horses naloxone is used in the control of crib biting.
o Dose
Naloxone
Dogs and cats = 0.04 - 0.1 mg/kg I.V/I.M/S.C
Horses 0.005 = 0.2 mg/kg I.V
Diprenorphin-Dogs & Cats = 0.0272 mg/kg I.V
Horse = 0.02 - 0.03 mg/kg I.V

Module- 10 => LOCAL ANAESTHESIA (Introduction)

Varieties of minor and major surgical procedures canbe accomplished in

domestic animals under local and regional anaesthesia, depending on the
species, breed, temperament of the animal, health status of the animal and
magnitude of the procedures.

LOCAL ANAESTHETICS
Cocaine

It is an extract from the leaves of Erythroxylon coca.

It is an irritant and toxic in small doses.
The toxic manifestations include clonic convulsions, loss of consciousness and
paralysis of medullary centres.
The maximum dose is 780 mg in horses, 120mg in large dogs, 45 mg in small
dogs and 15 mg in cats.
Cocaine was used as a doping agent in horses.
The lethal dose is 15 mg/kg.
Cocaine is withdrawn from the injectable forms due to its toxicity.
Only topical preparations are available for eye(4% solution) and nasal and
laryngeal areas (10 to 20% solutions).

Procaine hydrochloride

It is a short acting local anaesthetic derived from ester.

It is detoxified in the blood and liver rapidly.
The margin of safety is high in terms of convulsive dose (35 mg/kg in cats).
In clinical practice it is administered intravenously to relieve pain in fire
injured patients.
It is also used as adjunct to thiopentone sodium to maintain anaesthesia.
Procaine is combined with adrenaline 1 in 100000 to potentiate its anaesthetic
action.

Lidocaine hydrochloride

It is a fast acting amide local anaesthetic detoxified in the liver.

The convulsive dose is 15 mg/kg in cats.
Goats are extremely sensitive to lignocaine. The total dose should never be
exceeded 10 mg/kg in any route. The toxic manifestations in goats are
excitation, tonic clonic convulsions, opisthotonus, respiratory depression,
cardiac arrest and death.
Lignocaine is combined with general anaesthetics, which does not posses
convulsive properties as an ajunct (See injectable anaesthetics).
It is often combined with thiopentone due to its dysrhythmic property and
protective action on myocardium.
In clinical practice adrenaline free lignocaine is administered intravenously at
the rate of 0.25 mg/kg in cats and 2 mg/kg in dogs to control cardiac
arrhythmia due to myocardial ischemia.
The local anaesthetic preparationis marketed in combination with adrenaline 1
in 200000. It is also available as 2% jelly and 2.5% and 5% viscous ointments.
The duration of action is two hours.

Bupivacaine hydrochloride
 Bupivacaine is a fast and long acting amide derivative.
Its margin of safety is less.
The convulsive dose in cats is 3.4 to 5 mg/kg.
Intravenous administration induces mdyocardial depression.
Bupivacaine associated ventricular dysrhythmia are due to prolonged inhibition
of sedum conductance in the cardiac muscles.
It is not combined with general anaesthetics.
High molecular weight substance like dextran is added to prolong the duration
of action in obstetrical anaesthesia.

POTENTIATION OF LOCAL ANAESTHETICS

Epinephrine/Adrenaline - 1 in 1000000 or 1 in 200000 is added to increase the

intensity and duration of action.
Hyaluronidase - It increases the diffusion of local anaesthetics and favours
quick onset of action. It is added at the rate of 150 TRU (Turbidity reducing
unit) Addition of hyaluronidase will reduce the duration of action.
Dextran - High molecular weight substance is added to reduce the rate of
absorption and increase the duration of action.

TYPE OF NERVE BLOCKS

SURFACE ANALGESIA

Surface anaesthesia includes topical analgesia of skin, eye and mucous

membrane of nose, mouth, penis,vulva, urethra and rectum and intra synovial
analgesia.

TOPICAL ANALGESIA

Ice, ethyl chloride spray, ether spray and carbonic acid snow are used to
achieve superficial analgesia of the skin.
Absorbent cotton or gauze soaked in 4% procaine or 2% lignocaine is often
used on superficial aberrations of the skin and eczematous lesions to alleviate
pain.
Lignocaine 4% and proxymetacaine 5% (Ophthaine) are used as topical
anaesthetics for eye.
Analgesia of mucous membrane is induced for examination, catheterization or
intubation.
The commercial preparation containing lignocaine with carboxymethyl
cellulose is applied on mucous membrane.
This preparation is also used to lubricate catheters and endotracheal tubes.
Lignocaine 4% is sprayed on nasal or oral mucous membrane to achieve
analgesia.
In horses 60 ml of lignocaine 1% can be administered intra rectally to reduce
the discomfort during examination.
 INTRA-SYNOVIAL ANALGESIA

Intra-synovial analgesia is induced to relieve pain arising from the joint and
tendon sheath.
Often it is used in the diagnosis of lameness in horses.
Strict aseptic precautions muse bt adopted prior to injection.
Inadvertent introduction of infection will be disastrous.
If the needle is placed into the synovial cavity one can notice synovial fluid at
the hub of the needle.
Some quantity of synovial fluid is aspirated before injection into a distended
synovial cavity.
The intra-synovial injection techniques in horses are

Distal interphalangeal (coffin) joint

Site - in the midline approximately one centimeter proximal to the coronary

band with the needle angled slightly steeply than at right angles to the skin.
Needle and volume 19 G x1, 5 - 8 ml.

Proximal interphalangeal (pastern) joint

Site - Pastern joint is situated approximately 1 cm below an imaginary line

through the attachment of the collateral ligaments to the first phalanx.
The joint is entered near the midpoint on the dorsal midline approximately 3
cm proximal to the coronary band with the needle pointing obliquely
downwards and inwards.
Needle and volume 20 Gx 1, 5 - 8 ml

Metacarpophalangeal (fetlock) joint

Site - The fetlock joint is entered in the triangular space formed by the third
metacarpal bone, the proximal sesamoid bone and the suspensory ligament.
Can be performed with the limb weight bearing.
Needle and volume 20 G x 1, 10 ml

Digital flexor tendor sheath

Site - Usually performed onlyd in the presence of synovival distension. The site
of injection is the most prominent distended part of the sheath on the lateral
aspect of the digital flex or tendons just proximal to the fetlock.
Needle and volume 20G x 1, 10ml

Carpal joints
 Site - The two carpal joints into which inje3ction can be performed. (mid carpal
joint and antebranchiocarpal joint). The mid carpal joint opens with the
proximal (antebrachiocarpal joint) between the third and and fourth carpal
bones hence does not require separate injection. The joints can be entered on
the dorsal aspect of the flexed limb just lateral to the extensor carpiradialis
tendon.
Needle and volume 20G x 1, 10 ml.

Elbow joint

Site - The elbow joint can be entered either in front or behind its lateral
ligament. To enter in front of the ligament the needle is inserted just under
themargin of the lateral condyle of the humerus.
Needle and volume 19G x 2, 15 ml.

Shoulder joint

Site - The shoulder joint is entered horizontally between the anterior and
posterior part of lateral tuberosity of the humerous.
Needle and volume 19G x 3.5, 20 ml

Tarsometatarsal joint

Site - Over the head of the fourth metactarsal bone and fourth tarsal bone
Needle and volume 20G x 1, 5 ml

Stifle joint

Site -This joint has three synovial sacs, one in the femoropatellararticulation
and two, one medial and one lateral in the femoro-tibial artibulation.
Femoro-patellar sac can be entered on either side of the middle patellar
ligament.
Medial sac of the femoro-tibial articulation can be entered between the patellar
ligament and the medial femoro-tibhial ligament.
Lateral sac of the femoro-tibial articulation can be entered behind the lateral
patellar ligament. Another route is between the lateral femoro-tibial ligament
and the common tendon of the long digital extensor and the peroneus tertius.
Needle and volume 18G x 2, 20 ml each sac.

Hip joint

Site - Can be performed in standing horse. The needle is inserted between the
anterior and posterior parts of the trochantger major.
Needle and volume 2 mm x 15 cm
 INFILTRATION ANAESTHESIA

In this procedure the nerve ending is desensitized at the actual site of operation.
Depending on the duration one can use procaine, lignocaine or bupivacaine.
This form of analgesia is useful in the treatment of wound, skin incision,
extirpation of superficial tumors.
Following disinfection of the skin 0.5 to 1 ml of local anaesthetic is injected
intradermally before injecting into deeper tissues. This called as an intradermal
skin wheal.
Small circular wheals are created for catheterization of vessesl.
A linear continuous wheal can be produced by the use of a longer needle with
single prick and it reduces the number of pricks in case of paravertibral nerve
block.
There are two types of infilteration anaesthesia
o Line block
o Field block

LINE BLOCK

The needle is inserted parallel to the skin incision and for every 1 cm area of
incision 1 ml of the local anaesthetic solution is deposited.
The needle is withdrawn gently as the solution is deposited.
If the length of the incision is longer than the length of the needle the needle
can be inserted at the mid point of incision to preent multiple pricks.

FIELD BLOCK

Field block

Making walls of desensitized areas enclosing the operation or incisional site.

Production of a cup

A cup of desensitized area is produced by making fan wise injection.

Inveted L block

Two lenior infiltration at right angle in the form of an inverted L desensitizes

the flank region in cattle.

Ring block
 Used in the extremities like limb for amputation of digit in cattle or in teat for
teat surgery. Infiltration is done proximal to the site of operation.

Inverted V block

This is an another alternative method for ring block normally done in teat for
the repair of teat fistula.

Local anaesthesia of fracture

Lignocaine is directly injected into the haematoma of fracture site with through
aseptic precautions to relieve pain and favours closed method of reduction.

REGIONAL INTRAVENOUS ANAESTHESIA

This technique is used for amputation of limbs and digits.

A tight tourniquet or blood pressure measuring cuff is placed proximal to the
site of operation to block venous drainage.
Procaine or lignocaine is injected into the engorged superficial vein so as to
facilitiate the retrograde flow of blood and deposition and infiltration of local
anaesthetic into the tissues.
Bupivaccaine is not normally used in this technique due to its myocardial
effects.
Analgesia lasts as long as the cuff or tourniquet is in place and maintains the
pressure above the systolic blood pressure.

INFRA ORBITAL NERVE BLOCK

Nerve

Infra orbital nerve is the division of trigeminal nerve.

It supplies sensory nerve to the first and second molar (PM 1 & 2), canine and
incisors as it passes the canal.
After emerging from the canal it supplies sensory fibres to the upper lip, cheek,
nostrils and lower part of the face.

Site and technique

The nerve can be blocked either as it passes the canal or after emerging from
the canal using a 19 G x 5 cm needle.
The infra orbital foramen is located about one half the distance and 2.5 cm
dorsal to a line connecting the nasomaxillary notch and the rostral end of the
facial crest in horse.
In dogs the infra orbital foramen is situated in front of the anterior margin of
the PM 4 where it can be palpated.
 Its better to have the tip of the needle slightly curved to enter into the canal, 0.5
to 2 ml may be required in dogs and 10 ml in large animals.

Area desensitized

The skin of the lip, face of the side upto the level of the foramen is desensitized
if blocked at the level of the foramen. If it is blocked in side the canal in
addition to the above structures PM 1 & 2, canine, and incisors with their
alveoli and gum and the skin upto the inner canthus of the eye.

MANDIBULAR NERVE BLOCK

Nerve

Mandibular nerve is the alveolar branch of mandibular division of the

5th cranial nerve. It enters the mandibular foramen at the medial aspect of the
vertical ramus of the mandible. Then it passes through the mandibular canal
and supplies sensory dental and alveolar branches to the side. After emerging
out it is called as mental nerve and it supplies to the lower lip.

Site and technique

The nerve can be blocked as it enters the mandibular foramen or as it emerges

out from the mental foramen.
Mandibular block: The mandibular foramen is located opposite to the point of
intersection of a line passing vertically downwards from the lateral canthus of
the eye and another line extending backward from the tables of the mandibular
teeth. The site is selected medially 3 cm below the temperomandibular
articulation on the posterior boarder of the mandible. 4 to 6 ml of the solution is
deposited using along spinal needle.
Mental block: Mental foramen is easily located on the lateral aspect of the jaw
below the angle of the lip (in the middle of the interdental space) 3 to 5 ml of
the solution is deposited.

SUPRA ORBITAL NERVE BLOCK

Nerve

Supra orbital nerve (frontal nerve) is a sensory terminal branch of the

ophthalmic division of 5th cranial nerve. It emerges from the orbit through the
foramen accompanied with the artery. It supplies sensory fibres to the upper lip
andpartof the skin on the forehead.
Site and technique
 The foramen is palpated as a pit like depression midway between the upper and
lower borders of the supra orbital process close to the frontal bone (about 6-cm
dorsal to the medial canthus) 5 ml of the solution is injected with 19G x 2.5 cm
needle.
Successful block desensitizes the upper eyelid and the frontal region. Dogs do
not have supra orbital foramen.
The frontal nerve leaves the orbit medial to the ligament.

CORNUAL NERVE BLOCK

Cattle

Cornual nerve is a branch of lacrimal (zygomaticotemporal) division of

ophthalmic division of trigeminal nerve.
It supplies sensory fibres to the horn corium and the skin around the base of the
horn.
The nerve passes through the periorbital tissues dorsally and then runs along
the frontal crest to the base of the horn.

Goats

In goats the horn is supplied by the corneal branch of lacrimal

(zygomaticotemporal) nerve and corneal branch of infratrochlear nerve.
The infratrochlear nerve emerges from the orbit dorsomedially.

SITE AND TECHNIQUE

Cattle

As the nerve run from the orbit to the base of the horn it becomes more and
more superficial.
The block is done more easily 2 to 3 cm below the base of the horn with 5 to 10
ml of 2% lignocaine.
In cattle with large horn a second injection is given about 1 cm behind the first
to block the posterior division of the nerve.

Goats

The lacrimal branch can be blocked half way between the lateral canthus and
the lateral base of the horn.
The infratrochlear branch can be blocked half way between the medial canthus
and the medial base of the horn.
To amputate the horn at the base it is better to provide sedation, as this block
will not desensitize the perostium and sinus mucous membrane.
 RETROBULBAR NERVE BLOCK

Auriculopalpebral branch of the facial nerve - motor nerve (VII)

Oculomotor (III), trochlear (IV), and abducens (VI) nerves motor innervation
to the ocular muscles
Maxillary branch of the trigeminal nerve (V) - sensory innervation to lower
eyelid, soft palate, the nasal cavity, maxilla maxillary sinus and adjoining
bones and the region supplied by the infraorbital nerve.
Ophthalmic branch of the trigeminal nerve - sensory innervation to the upper
eye lid, third eyelid, medial canthus, caudal part of nasal septum, cornea and
sclera and the frontal sinus
Optic nerve (II)
For enucleation of eyeball all these nerves are blocked to achieve analgesia of
the eye and orbit and immobilization of the globe.

SITE AND TECHNIQUE

All these nerves except the optic nerve pass through foramen orbital.
Anaesthetic solution is deposited anterior to the foramen.
The notch formed by the supraorbital process, zygomatic arch and the coronoid
process of the mandible is located and a 18G x 7 to 11 cm needle is inserted
directed towards the opposite side last upper premolar until it reaches the
pterygopalatine fossa.
Deposit 15 ml of the solution. An additional 10 to 15 ml can be deposited
slightly caudodorsally as the needle is withdrawn.
This block does not provide desensitization of eyelids, hence for extirpation of
eye ball in addition to this the auriculopalpebral nerve block and infiltration of
eyelids mut be carried out.

PARAVERTIBRAL NERVE BLOCK

This regional anaesthesia is very important for bovine laparotomy.

The dorsal and ventral nerve roots of last thoracic (T13) and first and second
lumbar (L 1 & 2) spinal nerves are blocked as they emerge from the
intervertibral foramen.
If analgesia of caudal paralumbar area is required additionally the third lumbar
(L3) is blocked which result in weakness of the hind limb.

SITE AND TECHNIQUE

Each nerve is blocked immediately in front of the cranial border of the

transverse process of the succeeding lumbar vertebra.
The last thoracic nerve is blocked half way between the last rib and the
transverse process of the first lumbar vertebra about 5 cm from mid line.
 The first and second lumbar nerves can be blocked at the posterior edge of the
transverse process of the corresponding vertebrae about 5 cm from the mid
line.
The needle pricks are made through the subcutaneous wheals, to penetrate the
intertransverse ligaments and 15 ml of local anaesthetic is deposited below the
ligament and another 5 ml above the ligament.
Successful block shows analgesia of flank, paralysis of flank muscles, increase
in the temperature of flank, and scoliosis towards the desensitized side.
In horses the block is performed on T 18, L1 and L2.

EPIDURAL ANALGESIA

Epidural space is that compartment between the duramater and the bony and
ligamentous wall of the spinal canal.
This space is filled with extradural fat, internal vertebral plexus of veins and
the spinal nerves.
Injection of local anaesthetics will desensitize the nerves.
Normally the site is preferred after the end of cona medularis of the spinal cord.

SITE OF INJECTION IN DIFFERENT SPECIES

o Bovine - Sacrococcygeal junction between I & II coccygeal vertebrae

o Equine - Between I & II coccygeal vertebrae
o Canine - Lumbosacral space
o Swine - Lumbosacral space
o Sheep and Goats - Lumbosacral space
The terms high (anterior) and low (posterior) are often used to describe the
level of block.
If the block extends the segment from where the sciatic nerves arises (second
sacral and more cranial segments) the block is termed as anterior epidural.
The anterior epidural is achieved by increasing the volume of local anaesthetic
injected.
In high epidural or anterior epidural the animal will be recumbent and the
motor functions will be lost.

TECHNIQUE

Cattle and horse

The exact position of the sacrococcygeal junction or the space between the first
and second coccygeal vertebrae cn be located by palpating the borders with
simultaneous pumping of the tail.
3 ml of 2% lignocaine with epinephrine is injected in cows for low epidural
which will induce paralysis of tail, and analgesia of perineum rectum, and the
inner aspect of the thigh.
 Higher dose upto 120 ml of 2% lignocaine is administered in adult cow to
achieve high epidural in which the cow will be recumbent for more than 4
hours.
Sympathetic blockade and hypotension are common in high epidural.
In horses low epidural is induced using 5 to 7 ml of 2% lignocaine.
Analgesia of rectum tail, distal colon, bladder, and reproductive organs are
produced.

Swine

The site of needle placement is on the midline, just caudal to the transverse line
between the cranial prominences of the wing of the ilium on either side.
A 20G x 8 cm needle is inserted caudal to this line at an angle of 20 caudal to
the perpendicular.
Local anaesthetic is injected at the rate of 1 dml for every 10 kg. Hypotension
and death are more common in pigs following epidural analgesia.

Dogs

The site of injection is lumbosacral space which is located in the middle just
behind the line joining the highest points of these crests.
Some time the local anaesthetic is administered between sacrococcygeal or I
and II coccygeal vertebrae for docking.
The compliation of epidural anaesthesia includes hypotension, respiratory
collapse due to the block on higher levels, clonic spasms, convulsions (goats
are more sensitive), pareses or paralyses due to infection and fistula formation.

INTERNAL PUDENTAL NERVE BLOCK

This block is commonly done to induce relaxation and analgesia of penis to aid
in examination and treatment in cattle.
The lesser sciatic foramen is located by rectal palpation as a circumscribed
depression in the sciatic ligament.
The internal pudental nerve is found a finger width dorsal to the pulsating
pudental artery.
The block is done bilaterally on both the sides.
The ischorectal fossa is prepared aseptically and an 18G x 8 to 10 cm needle is
inserted and directed towards the nerve under rectal guidance 20 to 25 ml of
local anaesthetic is deposited and the process is repeated on the other side.
Penile relaxation and cutaneous analgesia over the anus, perineum, posterior
medial thigh and urethral opening are achieved.

ANALGESIA FOR CASTRATION

 Analgesia can be provided by injecting local anaesthetic into the spermatic
cord or directly into the testicle. The incisional site must be infiltrated
subcutaneously on the scrotum.

BRANCHIAL PLEXUS BLOCK

This block is mainly induced in dogs.

Successful analgesia will show all the symptoms of radial paralysis.
The brachial plexus in the dog is best blocked on its lateral recumbancy.
First the costochondral junction of the first rib is located by moving the upper
limb.
An 8 to 10 cm long needle is inserted towards the costochondral junction.
If the leg is held, as in the normal positionthe correct site of needle insertion
will be medial to the shoulder joint directed parallel to the vertebral column.
After reaching the costochondral junction the needle is withdrawn 0.5 to 1 cm,
then aspirated to ascertain that no blood vessel is punctured.
1 to 10 ml of 2%lignocaine is injected depending on the size of the dog.

MEDIAN AND ULNAR NERVE BLOCK

Median and ulnar nerve block will desensitize the carpus and structure distal to
it.
Median nerve is blocked at the caudomedial borner of the radius just distal to
the superficial pectoral muscle.
The nerve lies cranial to the median artery and vein. Skin desensitization
involves only the medial aspect of the pasern.
Ulnar nerve is blocked in the groove on the palmar aspect of the antebrachium
between the ulnaris lateralis and the flexor carpi ulnaris muscles, 10 cm
proximal to the accessory carpal bone at a depth of 1 to 2 cm.
Skin desensitization occurs on the dorsal aspect of the proximal metacarpus.
Needle and volume 20G x 1, 10 to 15 ml on each site.

TIBIAL AND PERONEAL NERVE BLOCK

Tibial and peroneal nerve block will eliminate deep sensation from the hock
and structures distal to it.
Tibial nerve is blocked just caudal to the deep digital flexor tendon and cranial
to the Achilles tendon about 10 cm proximal to the top of the tuber calcis on
the medial aspect of the limb beneath the fascia.
Skin sensation is usually lost between the bulb of the heel.
Peroneal nerve is blocked between the long and lateral digital extensor tendons
on the lateral aspect of the crust, 10 cm proximal to the lateral malleolus.
The peroneal nerve has deep and superficial branches.
10-ml of 2% lignocaine is injected around the deep branch and 5 ml around the
superficial branch as the needle is withdrawn.
Needle and volume 19G x 2, 20 ml on each site.
 PALMAR/PLANTAR DIGITAL NERVE BLOCK

The palmar/plantar nerve is desensitized in the palmar region of the pastern

joint medially and laterally.
Palmar nerve is formed by the fusion of the terminal branch of ulnar nerve and
the terminal branch of median nerve
Plantar nerve is the result of bifurcation of the tibial nerve.
Needle and volume 20 to 25 G x 2.5 cm, 2 ml on each site.
The area of desensitization includes pastern and one third of the hoof with
portions of navicular area.

MODULE-11: GENERAL ANAESTHESIA - INJECTABLE AGENTS

Learning objectives

This module deals with

Introduction to injectable anaesthetics

Routes of administration
Advantages and disadvantages of injectable anaesthetics
Classification of injectable anaesthetics

INTRODUCTION

Injectable anaesthetics can be administered through various routes.

The equipment required for administration of injectable anaesthetics is
minimal.
Following are the commonly used equipments
o Syringes
o Needles
o Butterfly needles
o Intravenous catheters.
Two types of intravenous catheters are available; they are
Through the needle catheters
 Over the needle catheters. Through the needle catheters
are long and used for long term administration of fluids.
12 to 16 gauge 5 inch catheters are used in large animals
and 18 to 22 gauge catheters are used in small animals.
(Refer Anaesthetic equipment)
o Infusion controllers and Syringe devises (refer Anaesthetic Equipment).

ROUTES OF ADMINISTRATION

Intravenous e.g. thiopentone in horses

Intramuscular e.g. ketamine in dogs
Intraperitonial e.g. thiopentone in cats
Intrathoracic e.g. thiopentone in cats
Intratesticular e.g. pentobarbitone in pigs for castration
Subcutaneous e.g. droperidol fentanyl in cats

ADVANTAGE AND DISADVANTAGE

Advantages

Simple to administer
Have rapid onset of action
Useful as induction agents
Does not irritate the airways
Non explosive and inflammable
Does not pollute the theatre
Controls convulsions
Disadvantages

May induce tissue damage if not injected through appropriate route

(thiopentone if administered perivascularly induce severe tissue reaction and
accidental administration of xylazine through carotid artery may cause fatal).
Excess dose administered without calculating the dose or patient evaluation
may cause toxicity. It may not be possible to recover the patient without the use
of specific reversal/antagonistic agents, oxygen supplementation, intermittent
positive pressure ventilation and other life saving supports.

CLASSIFICATION OF INJECTABLE ANAESTHETICS

Main category Examples
Barbiturates Thiobarbiturate e.g. thiopentone sodium,
thiamylal sodium
Methylated oxybarbiturate e.g. methohexitone
sodium
Oxybarbiturate e.g. phentobarbital sodium
Dissociative anaesthetics Ketamine hydrochloride
Titatamine
Phencylidine
Steroid anaesthetics Combination of Alphaxalone and alphadolone
e.g. Saffan, Althesin
Imidazole derivatives Etomidate
Metomidate
Alkylphenols Propofol
Opioid synthetic analgesics Fentanyl citrate
Alfentanil
Sufentanil
Lofentanil
Etorphine
Neuroleptanaesthetic mixture Droperidol and Fentanyl
Fluanisone and Fentanyl
Etorphine combinations
Centrally acting muscle Glyceryl Quaiacolate
relaxants
Chloral hydrate -

ULTRA SHORT ACTING BARBITURATE= >
The commonly used ultra short acting barbiturates are thiopentone sodium ,
thiamylol sodium and methohexitone sodium.
o Thiopentone and thiamylal - thiobarbiturates
o Methohexitone - oxybarbiturate.
These agents are strong alkalies (11 -12 pH) and the alkalinity is due to the
addition of sodium carbonate. Following administration, the blood buffers
neutralize the sodium carbonate. Thiopental and thiamylal are converted into
acid form, which bind with the plasma protein particularly with albumin
fraction. The narcotic and anaesthetic action is induced by the unbound
fraction. These agents produce dose dependent action varyhing from hypnosis
to general anaesthesia.
o Binding with protein depends on the drug concentration and the ptotein
level. Hence care must be taken in calculating the dose of thiopentone,
 thiamylal and methohexitone for hypoprotinemic animals. Unbound
fractions will be more and may cause profound depression.
o These agents produce unconsciousness in 30 to 90 seconds as they cross
the blood-brain barrier in one arm-brain circulation. The duration of
anaesthesia varies from 5 to 15 minutes.
o The recovery from anaesthesia is not due to the detoxification,
biotransformation and elimination, it is due to distribution. From the
blood it moves to the highly vascularised tissues and from there slowly
redistributed to less vascularised tissues. Initially the concentration in
the fat will be more. If fluids are administered during recovery the
redistributed fractions may be mobilized into the circulation resulting in
further deepening of anaesthesia. The distribution depends on the speed
and quantity injected. A small quantity injected rapidly as a bolus will
produce high plasma and brain concentration resulting in narcosis and
the recovery will be faster.
o The amount of thiopentone and thiamylal required to produce
anaesthesia vary from 10 to 18 mg/kg in small animals and 6 to 10
mg/kg in large animals. Anaesthesia is induced by administering half of
the calculated as a bolus followed by slow incremental doses to abolish
pedal reflex. Thiopentone and thiamylal are administered as 1 to 5%
solutions in dogs and cats and 5 to 10% solutions in horses and cattle.
o Methohexitone is administered as 1% solution in small animals and as
6% in large animals. The dose is 3 to 5 mg/kg intravenously.

CARDIOVASCULAR AND RESPIRATORY EFFECTS

Cardiovascular effects
o Barbiturates are potent cardiovascular depressants.
o They increase the heart rate and peripheral resistance with reduction in
cardiac out put and increasein central venous pressure.
o These actions are due to the reflex action secondary to the stimulation of
baroreceptors and chemoreceptors and myocardial hypoxia.
o Myocardial hypoxia may result in cardiac arrhythmia, bigeminy,
premature ventricular contraction and depression/elevation/slurring of S-
T segment.
o Administration of oxygen will prevent further manifestations.
o Lidocaine can be administered to control ventricular arrhythmia and it
can act as a useful adjunct if incorporated in the anaesthetic regimen.
o It prevents and corrects ventricular arrhythmia and reduce the
requirement of barbiturates. Separate syringes must be used for
administration to prevent the formation of precipitation.
Respiratory effects
o Ultrashort acting barbiturates induce severe respiratory depression even
at clinical doses.
o Rapid administration results in apnea during induction.
 o The changes are reduction in respiratory volume, tidal and minute
volume. If respiratory arrest is noticed it must be managed with oxygen
supplementation and mechnical ventilation.
o Artificial respiration by compressing the chest and stimulation of
respiratory reflex may help to over come apnea but may not be as
effective as oxygen supplementation.
o Thiopentone protects the ischemic brain hence used in patients with
brain injury and in cardiopulmonary bypass anaesthesia. Thiopentone is
used as an induction agent in patients suffering from epilepsy.
o These agents are metabolized in the liver and to a less extend in kidney,
brain and in other tissues. They are eliminated as alcohols, ketones,
phenols and carboxylic acids through urine. Microsomal enzymes of the
liver get elevated following administration of barbiturates.
o These agents do not cause prolonged decrease in gastrointestinal
motility. They produce sufficient muscle relaxation required for minor
surgery.
o Barbiturates readily cross the placental barrier and depress fetus.
However the amount of thiopentone transferred is not large enough to be
detrimental to the neonate at birth.

CONCURRENT USE OF OTHER DRUGS AND BENEFITS

Antichlolinergics
o Anticholinergics are administered to reduce salivation and prevent
bradycardia. In horses anticholinergics can be administered if they are
fasted for 6 to 8 hours.
o Atropine sulphate - Dogs & Cats = 0.044 mg/kg S.C/I.M, 0.022 mg/kg
I.V
o Glycopyrorolate - Dogs & Cats = 0.011 mg/kg I.M.
Tranquilizers
o Tranquilizers are administered to reduce the anxiety and the dose of the
anaesthetic drugs
o Triflupromazine - Dogs & Cats = 1.0 mg/kg I.V
o Acepromazine - Dogs & Cats = 0.1 - 0.2 mg/kg I.M., Horses = 0.06 -
0.1 mg/kg I.V/I.M.
o Chlorpromazine - Dogs & Cats = 1.1 - 2.2 mg/kg I.V/I.M.
o Xylazine
Dogs = 0.22 - 1.1 mg/kg I.V, 0.552.2 mg/kg I.M.
Cats = 0.5 - 1.1 mg/kg I.M.
Horses = 0.5 - 1.0 mg/kg I.V
Cattle 0.1 0.2 mg/kg I.V (combine anticholinergics)
o Diazepam - Dogs & Cats 0.04 mg/kg I.V
Neuraleptanalgesics
o Not safe to combine with barbiturates as the combined effects will be
extreme bradycardia, hypotension and cardiac arrest.
Narcotics
 o Narcotics markedly reduce the dose of barbiturates.
o Morphine - Dogs 0.11 0.66 mg/kg S.C, Cats not recommended
o Methadone - Dogs 0.11 0.55 mg/kg I.M/I.V, Cats not recommended
o Oxymorphine - Dogs 0.22 mg/kg I.V/I.M/S.C, Cats 0.88 --- 3.3 mg
total dose I.V/I.M/S.C
o Pentozocaine - Dogs & Cats 2.2 3.3 mg/kg I.M./S.C
o Innovar vet - Dogs 1 ml/7 to 9 kg I.M. , Cats not recommended
Muscle relaxants
o In large animals centrally acting muscle relaxant glyceryl quaiacolate
(Guaifenisin) is combined with barbiturates. 2 to 3 grams of thiopentone
is added to 50 grams of glyceryl guaiacolate and 5% solution of glyceryl
quaiacolate is prepared using 5% dextrose solution. Anaesthesia can be
induced by the intravenous administration of the solution at the rate of 1
to 2 ml/kg in horses.
o In dogs - succinyl choline, pancuronium, gallamine and other products
can be combined with barbiturates. Oxygen administration and
intermittent positive pressure ventilation are essential to maintain
respiratory and cardiovascular functions.
Procaine and lidocaine
o Procaine hydrochloride and lidocaine hydrochloride can be combined
with thiopentone and thiamylol. They should not be mixed in the same
syringe because the local anaesthetics are acidic and barbiturates are
alkaline. Every time the needle or the catheter must be flushed with
normal saline before administration of each agent.
o Advantages
Analgesia, Reduce the dose of barbiturates to 50% , Protects the
myocardium and brain from ischemic changes, Act as
antidysrhythmic agents and Provide good muscle relaxation.

LONG ACTING BARBITURATES

Pentobarbital sodium is the long acting barbiturate used in anaesthesia and is

marketed in vials containing 50 mg/ml and 65 mg/ml. Use of pentobarbital is
restricted to small animal and swine anaeshesia. The standard solution is
diluted and given intravenously.
Dose - Dogs & cats 20 - 30 mg/kg without premedication 10 - 20 mg/kg with
premedication. For continuous infusion an initial loading dose of 2 - 5 mg/kg is
given followed by 1 - 2 mg/kg/hr.
A special preparation containing 240 mg/ml of pentobarbital is available and is
used for euthanasia of animals. For euthanasia it is administered at the rate of
48 mg/kg (1 ml/5kg). This solution is often used to castrate large boars. The
solution is administered deep into both the testicles at a dose not exceeding 24
mg/kg. Castration is performed immediately after reaching light stage of
anaesthesia by ligation of the cord and emasculation. The testicles must be
disposed carefully otherwise dogs may get access and die due to poisoning.
 DISSOCIATIVE ANAESTHETICS

Ketamine hydrochloride and tilatamine are the commonly used dissociative

anesthetics in veterinary field.
Phencyclidine is another cyclohexamine product withdrawn from use because
of drug abuse.
The dissociative anaesthesia is characterized by
o Profound amnesia, superficial analgesia and catalepsy
o Involuntary spontaneous movements
o Persistence of reflexes like swallowing, pharyngeal palpebral and
corneal
o Large dose may induce convulsions
o Lack of muscle relaxation

KETAMINE

Ketamine is a popular anaestheic used in veterinary and human anaesthesia due

to its wide margin of safety and compatibility with other agents.
It was first synthezied in 1963 and introduced in human anaesthesia in 1965
and in veterinary anaesthesia in 1970.
Ketamine alters the central nervous system activity to sensory impulses without
blocking it at spinal cord or brain stem levels.
It allows the impulses to reach the cortical receiving areas but not perceived
because of the depression and dissociation of limbic system and other cortical
association areas.
It can cause seizures even in patients not known to be epileptic and may occur
even after 24 hours administrations.
The depression effects of ketamine are determined in the central nucleus of
thalamus, neocorticothalamic axis and nociceptive cells in the medial
medullary reticular formation.
Cardiovascular effects - Ketamine increases heart rate, cardiac out put,
peripheral vascular resistance, systemic and pulmonary blood pressure, cardiac
contractility and myocardial oxygen consumption. The cardiovascular
stimulation is attributed to
o Stimulation of sympathetic discharge
o Vagolytic activity and
o Negative inotropic effects on heart.
Respiratory effects - The effect of ketamine on respiratory functions are
increase in respiratory rate with or without decrease in tidal volume. Also the
partial arterial carbon dioxide level (PaO2) will increase with reduction in
partial arterial oxygen level (PaCo2).
Muscle relaxation will be poor hence must be used with other drugs which
produce muscle relaxation.
It induces copious salivation and lacrimation. Salivation can be controlled by
the prior administration of anticholinergics.
 Ketamine is metabolized in the liver and certain amount is excreted as
unchanged through urine.
Decreases total RBC counts due to the sequestration of RBCs in the spleen
Classical stress leukogram; leukocytosis with lymphopenia and neutrophilia
can be observed following ketamine administration.
Induces hyperglycaemia
Contraindicated in patients with increased intracranial pressure or in patients
who are undergoing brain or spinal cord surgery as it increases the
cerebrospinal fluid flow and pressure.
Not recommended for intraocular surgery as it increases the blood pressure and
intraocular pressure.
Ketamine maintains the uterine blood flow hence can be a useful alternative for
thiopentone in cardio vascular surgery.
The aims of combining ketamine with other agents are to achieve
o Muscle relaxation
o Eliminate side effects like salivation and recovery delirium.
o Improve visceral analgesia and
o Prolong the period of anaesthesia

DOSE RATE OF KETAMINE

Cats
o In cats the dose of ketamine is 10 - 30 mg/kg I.M. If it is combined with
narcotics, tranquilizers or sedatives the dose can be reduced to 5 - 15
mg/kg I.M. and 2- 5 mg/kg I.V.
o The standard protocols are
Xylazine 1.0 mg/kg I.M. and Ketamine 20 --- 25 mg/kg I.M.
Acepromazine 0.1 mg/kg I.M. and Ketamine 20 --- 25 mg/kg
I.M.
Midazolam 0.2 mg/kg I.M. and Ketamine 10 mg/kg I.M
Midazolam 0.2 mg/kg I.V and Ketamine 5 mg/kg I.V
Meditomidine 80 g/kg I.M. and Ketamine 2.5 7.5 mg/kg I.M.
Meditomidine 40 g/kg I.V and Ketamine 1.25 mg/kg I.V
Butorphenol 0.4 mg/kg I.M, Meditomidine 40 g/kg I.M. and
Ketamine 5 mg/kg I.M.
Butorphenol 0.1 mg/kg I.V. Meditomidine 40 g/kg I.M. and
Ketamine 1.25 mg/kg I.V
Dogs
o Xylazine 1 - 2 mg/kg I.M (lower dose in larger dogs) and Ketamine 10
mg/kg IM/IV
o Diazepam 0.2 - 5 mg/kg I.V and Ketamine 5 mg/kg I.V
o Meditomidine 40 g/kg I.M. and Ketamine 5- 7.5 mg/kg I.M.
o Butorphenol 0.1 mg/kg I.M, Meditomidine 25 g/kg I.M. and Ketamine
5 mg/kg I.M. 15 minutes later.
 Horses
o Xylazine 1.1 mg/kg I.V and 4 to 5 minutes after Ketamine 2.2 mg/kg
I.V. To prolong the anaesthesia half of the initial dose of both the drugs
must be repeated at every 10 to 20 minutes. Diazepam at the rate of 0.22
mg/kg I.V can be combined to reduce muscle fasciculation. Often
glyceryl quaiacolate is combined with xylazine and ketamine at the rate
of 50 mg/kg I.V and even administered as mixture to maintain
anaesthesia and this mixture gives good muscle relaxation.
Detomidine 20 g/kg I.V and Ketamine 2.2 mg/kg I.V
Promazine 1.0 mg/kg and Ketamine 1.5 2.0 mg/kg I.V
Acepromazine 0.05 09.10 mg/kg and Ketamine 2.2 mg/kg I.V
Cattle
o Xylazine 0.1 mg/kg and Ketamine 2 - 5 mg/kg I.V
o Detomidine 20 g/kg and Ketamine 2 - 5 mg/kg I.V
Sheep and Goats
o Xylazine 0.04 - 0.06 mg/kg and Ketamine 2.2 - 4.4 mg/hg I.V
o Detomidine 40 g/kg and Ketamine 2.2 - 4.4 mg/kg I.V
Pigs
o Xylazine 2 mg/kg, Oxymorphone 0.075 mg/kg and Ketamine 2 mg/kg
I.V
o Acepromazine 0.4 mg/kg and after 30 minutes Ketamine 15 mg/kg I.M.
o Acepromazine 0.44mg/kg, Xylazine 2.2mg/kg and Ketamine 1230
mg/kg I.M
o (Further maintenance is done with a mixture containing 0.5 to 1 ml of
xylazine (100mg/ml) and 1 ml of ketamine (100mg/ml).

TILATAMINE

Tilatamine is closely related to ketamine and is two to three times potent than
ketamine.
It induces muscle rigidity and tonic-clonic convulsions if administered alone
hence it is marketed in combination with a benzodiazepine Zolazepam.
(Telozol in USA and Zoletil in Australia) It contains 250 mgs of tilatamine and
250 mgs of zolazepam. This combination provides muscle relaxation and a
dissociative state of anaesthesia in dogs, cats and wild animals. Its use in horses
may result in potential severe reactions. Premedication with xylazine
minimizes the adverse reactions in horses.
Animals anaesthetized with telozol zolazepam will respond to palpebral,
laryngeal, pharyngeal, pedal and pinnal reflexes. Salivation is more marked and
can be controlled by the use of anticholinergic premedication. Anticolinergic
premedicationis very important while using this combination
Dossage
o Cat @ 7 - 15 mg/kg I.M; 5 - 10 mg/kg I.V
o Dog @ 10 - 15mg/kg I.M; 5 - 7 mg/kg I.V
o Horses
o Xylazine 0.5 - 1.0 mg/kg
 o Tilatamine zolazepam 0.5 - 1.0 mg/.kg I.V

STEROID ANAESTHETIC

Combination of alphaxalone and alphadolone is marketed as Saffan (in

veterinary) and Althesin (in human).
Alphaxalone is insoluble in water and can be dissolved in Cremophor EL
(polyoxyethylated caster oil).
Alphadolone is another steroid which has hypnotic property and increase the
solubility of alphaxalone in cremophor.
Each milliliter of Saffan contains 9 mgs of alphaxalone and 3 mgs of
alphadolone. This preparation is viscid and the pH is around 7.
Saffan froths in syringes due to the presence of cremophor EL and is miscible
with water.
Low solubility of these steroids in water made them less popular.
Saffan is used in cats.
In dogs it induces histamine release and causes severe hypotension hence not
recommended in dogs.
It selectively decreases cerebral oxygen consumption to a greater extend by
reducing the blood flow. Indicated in cats with head injuries.
Retching, vomiting and twitching of facial muscles may occur during
induction.
In cats it does not induce significant change in cardiac index and systemic
vascular resistance.
It induces respiratory depression.
It poduces good muscle relaxation.
It can be used in cats for caesarian section because the neonates are less
depressed at the dose of 4.0 mg/kg. Some trials have been conducted on dogs
for caesarian section. All the dogs were given prior anti histaminic medication
and premedicated with phenothiazines.
It may cause oedema of ear pinnae and paws in cats due to histamine release.
It has got week antioestrogenic effect
It may induce laryngeal oedema
In horses it produce excitement for upto 30 minutes during induction and
recovery is associated with marked tactile and hyperaesthesia, twitching and
violent kicking. It is not recommended in horses.
Dose
o Cats 4 - 6 mg/kg I.M/I.V
o Pigs 4 - 6 mg/kg I.V
o Pig neonates 2 - 3 mg/kg I.V
o Sheep 1.65 - 3 mg/kg I.V
 IMIDAZOLE DERIVATIVES

Metomidate

Metomidate is a non-barbiturate crystalline power belonging to imidazole

group.
In room temperaturethedissolved solution is stable only 24 hours.
Metomidate has hypnotic and central muscle relaxant property, but does not
have analgesic property hence oftencombined with fentanyl or azaperone
premedication.
It is mainly used in pigs and birds.
In horses it was used with azaperone (0.2 0.8 mg/kg) at the rate of 3.5 mg/kg
I.V. Recovery was violent. It is not recommended in horses.
Dose
Birds 3 - 20 mg/kg I.M

Etomidate

Etomidate is a white crystalline power available as 20 mg dissolved in 10 ml of

a mixture containing 35% propylene glycol and 65% water (v/v).
Intravenous injection is associatred with high incidence of spontaneous
movements, involuntary muscle tremors and hypertonus.
Premedication with fentanyl or diazepam reduces the side effects.
It induces less cardiovascular depression and does not release histamine. Hence
it is used in dogs for caesarian section at the dose of 1.5 - 3.0 mg/kg I.V along
with diazepam (0.2 mg/kg I.V total dose not exceeding 5 mg).
Etomidate is recommended in high risk allergic patients who had exhibited or
are expected to exhibit severe anaphylactic responses.
Etomidate like thiobarbiturates decrease the circulating cortisol concentration
in hyperadrenocortism, hence can be used as safe induction agent in these
patients.

ALKYLPHENOLS

Propofol is a lipophilic alkylphenol (2-6 diisoprophylphenol) becoming popular

in human and veterinary anaesthesia.
It is an oil at room temperature and can not be injected hence was formulated
with Cremaphor EL (polyoxyethylated casteroil) as vehicle.Cremaphor EL as
 with other agents induced histamine release in human and animals. Now the
vehicle is changed and reformulated with a parental nutritional agent called as
Intralipid which contains soybean oil, glycerol and purified egg phosphatide.
The new formulation is milky in colour. The vehicle added favors bacterial
growth hence the open ampule after 6 to 12 hours must be discarded.
Propofol induce rapid loss of unconsciousness in 20 to 40 seconds after I.V.
administration due to its lipophilic nature.
It crosses the blood-brain barrier in one arm-brain circulation and further
redistributed from plasma, brain and well-perfused tissues to less perfused
tissues as thiopentone.
Recovery periods are shorter without any undesirable side effects in propofol
anaesthesia half of the calculated dose in infused as a bolus and the remaining
half is administered in a slow phase.
Propofol can be administered in continuous infusion to maintain anaesthesia.
It is conjugated in the liver and metabolized as glucuronide and sulphate and
excreted in urine.
Cardiovascular effects - Propofol induce 20 to 40% reduction in arterial blood
pressure due to reduction in cardiac output and systemic vascular resistance. Its
use is cautioned in dogs with serious volume depletion.
Respiratory effects - Propofol induce apnea and greater respiratory depression.
Propofol does not affect hepatic and renal functions
It can be used for long term sedation and anaesthesia in intensive care patients,
as it does not alter adrenocortical function.
It reduces the intraocular pressure hence can be used in patients undergoing
intraocular procedures
Propofol is a good induction agent for caesarian section in dogs and cats. It
reported that the puppies were bright and the mother was alert enough to care
the puppies immediately following recovery.
It is a safe anaesthetic in branchycephalic breeds of dogs.
Dose -
o Dogs
3 - 4 mg/kg I.V. in premedicated,
5 - 6.5 mg/kg I.V. in Unpremedicated (continuous infusion 0.4
0.6 mg/kg/minute)
o Cats
8 mg/kg I.V. inunpremedicated (continuous infusion 0.51
mg/kg/minute)
o Horses
2.0 mg/kg with xylazine 0.5 mg/kg I.V.(continuous infusion 0.2
mg/kg/minute)
o Sheep and goats = 3 - 4 mg/kg I.V
o Rabbit = 7.5 - 15 mg/kg I.V
o Mouse = 26 mg/kg I.V
o Birds = 1-15 mg/kg I.V
o Reptiles = 10 mg/kg
 PURE AGONISTS - MORPHINE

Morphine is derived from the dried milky exudates of the unripe seed capsules
of the opium poppy (Papaver somniferum).
The exudates contains 3-25% of morphine, 5% noscapine and 0.8%
papaverine.
The laboratory synthesis of morphine is different hence still it is derived from
opium poppy. The laboratory synthetic agents are codeine, heroin (dimorphine
= diacetylmorphine) and oxymorphine.
Morphine acts and produces
o Analgesia
o Drowsiness
o Produce nausea and vomiting by stimulating chemoceptor trigger zone
for vomiting. It induces dopaminergic excitement in cats, horses, pigs,
dogs and cattle.
o Induce respiratory depression
o Depress cough
o The effects on myocardium are not significant; but produce increase in
vagal tone and slowing of heart.
o Morphine is used as a postoperative analgesic for pain relief in
veterinary practice.
o Morphine decreases motility of stomach with increase of antral portion.
Initial use may cause defecation and chronic use will result in
constipation.
o It is absorbed from the gut and oral mucosa.
o It is used in the treatment of congestive heart failure to relieve pain and
decrease after load.
o Preservative free morphine can be administered epidurally to relieve
pain.
Dose
o Horses Morphine gives good results in horses if administered after
xylazine sedation. Xylazine 1.0 mg/kg I.V and morphine 0.6 mg/kg I.V
o Dogs 0.2 0.5 mg/kg (total dose not exceeding 10 mg) I.M/I.V
o Cats 0.05 0.1 mg/kg S.C/I.M. must be administered with caution
because it may induce CNS stimulation. Hence must be used with
suitable tranquilizer.
o Morphine is administered after administration of Acepromazine.
Acepromazine 0.1 mg/kg I.M. and Morphine 0.6 mg/kg I.M.

PATHADINE, MEPERIDINE AND OXYMORPHONE

Pathadine
o Pathadine is a vagolytic and negative inotropic drug at clinical doses.
o It reduces salivation and respiratory secretion without inducing vomiting
and defecation.
 o Pathadine induces histamine release if administered through intravenous
route.
o Dose
Dogs = 2 - 6.5 mg/kg S.C/I.M
Catls = 2 - 4.4 mg/kg S.C/I.M
Meperidine
o It is a synthetic product, less potent (one tenth of morphine) and used in
dogs and cats.
o Intravenous administration causes release of histamine hence most often
used along with acepromazine. (Phenothiazines are potent
antihistaminics)
o Dose: Dogs and Cats 2-5 mg/kg I.M
Oxymorphone
o Oxymorphone is a synthetic derivative having 10 times greater potency
than morphine.
o It is widely used in dogs and cats for its analgesic property. Analgesia
lasts for 4 hours.
o It does not cause histamine release as meperidine.
o It is used popularly in small animal anaesthesia due to its analgesic and
lack of release of histamine.
o The only limitation with drug is stimulation of vagus leading to
bradyarrhythmias and it can be reduced or prevented with the use of
antichlinergic agents in the protocol.
o It is also administered epiduraly to control pain in the hindquarters
(0.025 - 0.05 mg/kg).
o Dose
Dogs 0.05 - 0.2 mg/kg I.V/I.M/S.C (total dose not exceeding 4.5
mg)
Cats 0.05 - 0.4 mg/kg I.V/I.M/S.C
Horses 0.02 - 0.03 mg/kg I.V/I.M.

FENTANYL CITRATE AND ETORPHINE

Fentanyl citrate

Fentanyl is a synthetic opioid product related to phenylpiperidines.

Its analgesic property is 80 times greater than morphine.
Cardiac out put, heart rate, respiratory rate and arterial oxygen tension (PaO2)
are reduced following administration of fentanyl.
Fentanyl citrate is available alone, or in combination with droperidol
(Innovar vet contains 0.4 mg of fentanyl and 20 mg of droperidol per milliliter)
or fluanisone. (Hypnorm contains 0.315 mg of fentanyl and 10 mg of
fluanisone per milliliter) Fentanyl combinations provides good intra operative
analgesia.
In dogs and primates it produces sedation and myosis whereas in horses it
produces excitement and mydriasis. It is not recommended in cats.
 Dose - Dogs 0.01 - 0.02 mg/kg I.M/I.V. (see butyrophenones for other doses).
The other synthetic pure agonists are afentanil, sufentanil, lofentanil and
carfentanil.

Etorphine

Etorphine is a potent synthetic morphine derivative. Its general properties are

similar to morphine.
The dose of etorphine is 0.5 mg/500 g B.W
Etorphine is an extremely long acting agent whose effects are maintained by
enterohepatic recycling.
The action of this drug can only be terminated by the administration of the
specific antagonist Diprenorphine.
In clinical dose etorphine along may produce initial excitement hence it is
marketed in combination with phenothiazine derivatives. Separate
combinations are available for large and small animals. Each pack of the
marketed drug will be having two components. 1-Immobilon and 2-Revivon.

Preparation

Immobilon L A contains Etorphine 2.45 mg/ml and acepromazine 10 mg/ml

Immobilon S A contains Etorphine 0.074 mg/ml and Methotrimeprazine 18
mg/ml
Revivon L A contains Diprenorphine 3.0 mg/ml
Revivon S A contains Diprenorphine 0.272 mg/ml
This mixture is popularly used to capture elephants and giraffes
Not recommended for domesticated and wild felines
Etorphine is extremely potent in human and any accidental injection may cause
death if not treated with naloxone or diprenorphine.

PENTAZOCAINE, BUTORPHENOL TARTRATE AND BUPRENORPHINE

Pentazocaine
o It is used as an analgesic.
o In human it causes dysphoria and hallucination and pentazocaine is
developed to prevent drug abuse.
o In clinical doses it produces pulmonary vascular resistance.
o In horses it is used in the treatment of colic and administered at the rate
of 0.33 mg/kg I.V.
o Dose -3 mg/kg for 1 to 3 hours of analgesia.
o Penlog -Duration of analgesia 3-4 hour .Onset 1 min one hour
Butorphenol tartrate
o Butorphenol is used in horses, cats and dogs.
o It produces sedation, analgesia and increase in pulmonary vascular
resistance.
o Dose
 Horse = 0.1 mg/kg I.V
Dogs = 0.2 0.8 mg/kg I.M/S.C
Cats = 0.2 0.4 mg/kg I.V/I.M/S.C
Onset 1 mint 15 mint I.V. rapid
Buprenorphine
o Respiratory depression is more and often treated with intermittent
positive pressure ventilation.
o Dose
Horses = 6 - 10 g/kg
Dogs = 0.01 - 0.02 mg/kg S.C/I.M/I.V
Cats = 0.005 - 0.02 mg/kg S.C/I.M.

CENTRALLY ACTING MUSCLE RELAXANTS (guaifenisin)

Glyceryl quaiacolate ether (Guaifenisin) is the centrally acting muscle relaxant

and it acts on the internuncial neurons of the spinal cord.
It affects the polysynaptic reflexes more than monosynaptic reflexes hence it
has got little action on the diaphragm.
It does not influence the respiratory canters in brain. Diaphragmatic muscle is
composed of mainly striated titanic fibers and not striated tonic fibers; hence
GGE does not affect the diaphragm.
It also induces sedation and hypnosis due to its action on the reticular
formation of the brain stem.
It has got bactericidal action. In practice, it is administered as 5% (50 mg/ml)
solution in 5% dextrose.
Concentration greater than 10% is irritant to body tissues and can induce
haemolysis. GGE dissolves readily in 5% dextrose if warmed slightly.
GGE is used in combination with other agents in 5% dextrose solution as
induction and maintenance agent. These mixtures are administered after routine
premedication.
The maximum dose of GGE is 90 to 100 mg/kg and if this dose is exceeded it
will cause spasm, hypertonicity of muscles and cardiac arrest.
GGE does not cross the placental barrier due to its high molecular weight.

Horses
 GGE 50 mg/ml (5% solution) in 5% dextrose mixed with xylazine 0.5 mg/ml
and ketamine 1.0 mg/ml is the routinely used mixture in horses.
Induction is achieved at the dose rate of 1.1 ml/kg and further maintenance is
done with this mixture at the rate of 2.75 ml/kg/hour. Alternatively induction
can be done using xylazine (1.1 mg/kg I.V) and ketamine (2.2 mg/kgIV)
andfurther maintenance can be done with this mixture.
GGE can be combined with thiopentone or thiamylal (1-3 grams) and
administered in horses (See barbiturates)

Cattle

GGE 50 mg/ml (5% solution) in 5% dextrose mixed with xylazine 0.05 mg/ml
and ketamine 1.0 mg/ml is the mixture used in cattle. 1.0 ml/kg I.V is
administered for induction and further maintenance can be done with this
mixture.

PURE ANTAGONISTS

Naloxone hydrochloride, nalorphine hydrochloride and diprenoorphine are the

opioid pure antagonists used for the reversal of the effects of pure agonists and
partial agonists.
In horses naloxone is used in the control of crib biting.
DoseNaloxone-- Dogs and cats = 0.04 - 0.1 mg/kg I.V/I.M/S.C

Horses -- 0.005 = 0.2 mg/kg I.V

Diprenorphine- Dogs & Cats = 0.0272 mg/kg I.V

Horse = 0.02 - 0.03 mg/kg I.V

CHLORAL HYDRATE

Chloral hydrate is used as a reliable sedative hypnotic in cattle and horses.

It is less expensive and still perfectly acceptable sedative agent.
It has deeply penetrating aromatic odour and is bitter in taste.
The central nervous system depression is due to its metabolic product namely
2,2,2 trichloro ethanol, hence the sedative effect is prolonged even after
cessation of administration.
It does not have analgesic property.
Trichloro ethanol conjucates with glucuronic acid to urochloralic acid and
excreted.
Chloral hydrate depresses the motor and sensory responses at sedative dose and
produces cerebral and medullary center depression at anaesthetic dose resulting
in muscle relaxation and depression of cardiac and respiratory system.
In cattle it can be drenched preferably through stomach tube, at the dose of 30
to 120 grams dissolved as 1 in 20 solution in water.
 Bullls that are uncontrollable and free in the yard can be controlled by water
deprivation for brief period and allowing them to drink chloral hydrate
dissolved water (90 to 120 grams in 12 litres of water).
Chloral hydrate is administered as 10% solution intravenously in cattle at the
dose of 80 to 90 mg/kg.
Chloral hydrate is combined with magnesium sulphate at 2:1 or 3:1 ratio
(weight) and administered in cattle.
It is combined with magnesium sulphate and pentobarbital and administered to
horses (Equithesin mixture).
Intravenous dose of chloral hydrate in horses
o Chloral hydrate alone 5 to 10 mg/kg for mild sedation and hypnosis, 20
to 40 mg/kg for moderate sedation and hypnosis, 50 to 75 mg/kg for
profound sedation and hypnosis and 150 to 250 mg/kg for anaesthesia.
o Chloral hydrate 100 mg/kg and thiopentone 1.5 to 2 mg/kg
o Chloral hydrate 100 mg/kg and ketamine 1.5 to 2 mg/kg
o Promazine 0.6 to 0.8 mg/kg, 7% chloral hydrate 20 to 40 mg/kg and
thiopentone 5 to 7 mg/kg
o Acepromazine 0.04 to 0.08 mg/kg, 7% chloral hydrate 20 to 40 mg/kg
and thiamylal 2 to 4 mg/kg.
o Xylazine 0.4 to 0.6 mg/kg, 7% chloral hydrate 20 to 40 mg/kg and
thiamylal 1 to 2 mg/kg.
Disadvantages of chloral hydrate
o Prolonged hangover with ataxia and stupor
o Perivascular administration causes pain, swelling and necrosis
o Induces abortion in mares

MODULE-12: GENERAL ANAESTHESIA - INHALANT ANAESTHETIC

AGENTS AND MAINTENANCE

Learning objectives

This module deals with

Inhalant Anaesthetic Agents and

Its Maintenance

INTRODUCTION

The inhalant anaesthetics are chloroform, ether, trilene, cyclopropane,

enflurane, desflurane, halothane, isoflurane and sevaflurane.
Their uptake and distribution determine the anaesthetic action of these inhalant
agents.
The uptake and distribution depends on
Solubility coefficient - At any given temperature the mass of a gas dissolved in
a solution (i.e. its concentration in the solution) varies directly with its tension
 and is governed by the solubility of the gas in the particular solvent. For
example the blood gas partition coefficient of nitrous oxide is 0.47. This means
that there will be 47 parts of nitrous oxide inblood for every 100 parts of
nitrous oxide per unit volume (litre) of alveolar air. The solubility of most of
the inhalant agents in brain and other tissues except fat are almost common as
that of blood. That means the tissue blood partition coefficient will be almost
the same. Whereas halothane is almost 60 times more soluble in fat than other
tissues; hence the blood partial coefficient will be lesser than the fat. Brain
lipid (fat) coefficient will be almost equal (2.6) because of the lipid nature of
brain.
Blood flow - The inhaled anaesthetic gas is diluted in the residual air when it
enters pulmonary ventilation and then distributed to alveolar membrane. From
alveolar membrane two types of diffusion take place. The major diffusion
process takes place into the pulmonary blood (pulmonary circulation) and it
reaches equilibrium with alveolar tension immediately. The second process
occurs across the capillary membrane of the lung into the interstitial fluid, then
to the cells through the cell membrane and finally into the venous blood
leaving the lung (bronchial circulation). In thismanner the arterial and venous
tension of the anaesthetic slowly increases towards the ventual equilibrium
with the inspired air.
Solubility of inhalant anaesthetic is defined as a concentration distribution ratio
between alveolar concentration and the tissue concentration. The solubility of
inhalant anaesthetics influences the induction and recovery time.
Methoxyflurane is highly soluble than isoflurane in the body tissues hence the
induction and recovery will be slow.
Mininimum alveolar concentration (MAC) - MAC is the concentration of the
inhalant anaesthetic in the alveoli to produce lack of response in 50% of the
subjects to a standard stimulus. This term is used to mention the potency of the
anaesthetic. The MAC of each inhalant anaesthetic varies in each species.
The other factors are
o Physical and chemical properties of the agent
o Absorption
o Pulmoanry blood flow
o Cardia output perfusion
o Lipid content of tissues
o Final elimiantion

NITROUS OXIDE

Nitrous oxide is the oldest anaesthetic gas available as liquid at room

temperature in cylinders (See anaesthetic equipment).
Its MAC is more than 100% in animals (Dogs 188%, Cats 255%).
It has got good analgesic property and combining narcotics, which interact
selectively with opiate receptor endorphin system, potentiates the analgesia.
 Nitrous oxide is used as the principle anaesthetic at a level of 80% in
combination with 20% oxygen for dental extraction in human. In veterinary
anaesthesia, it is combined with other injectable and inhalant agents.
It is used as fresh gas source or carrier gas. It helps in additional uptake of the
inhalant agent and potentiate the desirable effects at a minimal concentration of
the inhalant agent (Second gas effect).
It is eliminated rapidly from the body because of low partition coefficient and
relatively insoluble nature.
Nitrous oxide moves rapidly through tissues faster than carbon dioxide and
diffuses into the closed cavities filled with gas such as pneumothorax and
distended intestinal loops due to obstruction or strangulation and induces
detrimental effects by inducing further distension.
It is not used in ruminants, as it will diffuse into the rumen and results in
distension and increase in transdiaphragmatic pressure. In horses prolonged
administration induce distension of bowels and increase in transdiaphragmatic
pressure.
It induces tachypnoea at higher concentration due to direct central stimulation.
During recovery it may induce diffusion hypoxia following prolonged
administration. The outward movement of nitrous oxide from the alveoli
reduce the alveolar partial pressure of oxygen. The expired air may contain
more than 10% of nitrous oxde. In older animals and animals maintained for a
longer duration with nitrous oxide must be supplemented with oxygen.
Prolonged exposure to nitrous oxide causes bone marrow depression due to
depletion of Vit.B12. Hence it can cause occupational hazards to humans. The
theatre environment must have less than 25 ppm of nitrous oxide.
Nitrous oxide is administered at 66 to 70% of the total inspired air. Oxygen is
given at 30% concentration.

DIETHYL ETHER

It is a colourless, highly volatile and inflammable liquid with a boiling point

35oC.
One pound of ether mixed in air can given 277 cubic feet of flammable
mixture. The ignition temperature is 304 C.
The MAC is 1.92%.
It gives an irritating vapour and may cause salivation if not premedicated with
anticholinergics.
In low concentration the vagal activity is decreased and at higher concentration
it induce arrhythmia.
Catecholamine level increases following ether administration.
The use of ether is decreased due to its explosive and inflammable nature.
Health hazards are more in human exposed to ether for a prolonged period.

METHOXYFLURANE
 Methoxyflurane is a halogen-substituted ethyl ether (O2,2-dichloro-1,1 difluoro
ethyl methyl ether).
Its boiling point is 104oC and is non-flammable and nonexplosive. Its
molecular weight is 165.9 and the specific gravity is 1.41 at 25oC.
It has fruity odour and an antioxidant butylated hydroxyflurane is added for
stability.
This antioxidant may accumulate in the vaporizer wick hence methoxyflurane
vaporizer must be often cleaned and rinsed with diethyl ether.
The MAC is 0.23.
It reacts with metal, rubber and soda lime, and decomposes if exposed to
ultraviolet light.
Methoxyflurane induce dose dependent central nervous system depression.
Though it can be used to mask induction, its better to induce with injectable
anaesthetics.
It does not alter the cardiac function much except slight hypotension, which is
associated with reduction in cardiac contractility, and cardiac out put.
Concurrent use of epinephrine and adrenaline are contraindicated as
methoxyflurane sensitizes the myocardium to the actions of catecholamines.
Compared to halothane the sensitization and cardiac arrhythmia are less.
Methoxyflurane reduce the minute volume and induces respiratory acidosis.
It is highly soluble in fat hence recovery will be prolonged in obese patients.
Biotransformation of methoxyflurane results in fluoride ions, which are potent
toxic agents to kidneys and is further aggravated by the concurrent use of
tetracycline. Methoxyflurane is contraindicated in patients with renal disease.
In veterinary practice its use is restricted to small animals.
It can be used in most of the breathing circuits with oxygen and nitrous oxide.

HALOTHANE

Halothane is colourless volatile liquid with aboiling point of 50.2oC and the
vapour pressure is 244.1 mmHg at 20oC.
It is non-flammable and nonexplosive.
Halothane is a potent anaesthetic with a molecular weight of 197.4 and specific
gravity 1.86 at 25oC.
Halothane reacts with metal and soda lime and decomposes if exposed to ultra
violet light.
It is marketed in amphor coloured bottles with thymol.
The MAC varies in various species.
o Dogs 0.87%,
o Cats 0.75%,
o Horses 0.9%
o Pigs 1.25%
The MAC is reduced when combined with agents like morphine (reduced
84%), alfentanil (48%), xylazine and nitrous oxide.
 Halothane reduces cerebrospinal fluid production and pressure hence can be
used in patients undergoing brain and spinal cord surgeries and in patients with
increased intracranial pressure.
It suppress adrenal cortical hormone release by 50% due to its action and
inhibition on the carrier - mediated transport system of choline.
Halothane depress cardiac out put,mean arterial pressure and coronary blood
flow.
Halothane decreases arrhythmogenic thresholds and sensitizes the myocardium
for the actions of catecholamines. Exogenous administration of epinephrine or
adrenaline induces cardiac arrhythmia and ventricular stand still.
It induces AV shunts (arterio-venous shunts) and is further aggrevated by
hypoxia. (21 to 22%) thus resulting in ventilation perfusion mismatch. Oxygen
exchange is further reduced in patients with pulmonary diseases.
The minute volume decreases during halothane anaesthesia due to the
decreased contractility of inspiratory muscles.
Halothane induces hepatic hypoxia. In ponics following halothane anaesthesia
138% increase in plasma bilirubin excretion, 16% reduction in plasma bilirubin
and 46% reduction in biliary bile acid concentration was noticed. Centrilobular
necrosis is the toxic manifestation induced by halothane in liver. The
incidencesof hepatic necrosis are higher in goats following halothane
anaesthesia.
Halothane undergoes biotransformation in the liver. The metabolic products or
the intermediary products induce allergic and toxic responses similar to
autoimmune diseases. The metabolic intermediary products bind with the
bivalent genes responsible for self-protein synthesis in the liver. Following
binding the genes will alter the coding and non-self protein will be synthesized
which may result in allergy, anaphylaxis or autoimmune like diseases.
Experimental studies revealed that halothane has got teratogenic and mutogenic
properties. In human the rate of successful deliveries following embryo transfer
or gamete intra fallopian transfer were less as compared with isoflurane. Initial
conception rate was high followed by higher incidence of aborption.
Halothane suppress the number and activity of natural killer cells (NK cells)
and produce immune suppression, thus favouring higher incidences of post
anaesthetic infection. This property is taken as an advantage in patients
undergoing tissue transplantation. Its better to revaccinate horses with tetanus
toxoid following halothane exposure.

ISOFLURANE

Isoflurane is the new inhalant anaesthetic widely used in human anaesthesia.

It is relatively insoluble hence induction and recovery are quick.
It is non-inflammable and does not react with metal, rubber or soda lime.
It does not decomposed if exposed to ultra violet light.
Its vapour pressure is almost equal to halothane hence halothane vaporizers can
be used after cleaning thymol. It has got pungent odour.
 It provides cardiac stability. Reduction in blood pressure is noticed during
isoflurane anaesthesia due to the reduction in peripheral vascular resistance, not
due to myocardial depression as in halothane. It increase the myocardial
perfusion by reducing the coronary vascular resistance. It has little or no action
on sensitizing the myocardium for the actions of catecholamines. Hence it is
recommended in patients with cardiac diseases.
It does not interfere with of central autoregulation of blood pressure, hence
indicated in patients with head injures.
It has better muscle relaxation property than halothane and does not promote
convulsions.
It induces more respiratory depression than halothane and results in
hypoventilation.
Only 2% are metabolized in the liver due to its relative insolubility, hence
recommended in patients with liver diseases.

SEOFLURANE

It is the newest inhalant anaesthetic used in humans. Still trials are conducted in
veterinary anaesthesia.

PROPERTIES OF INHALANT ANAESTHETICS

Property Halothane Isoflurane Sevoflurane
Formula CBrCIH-CF3 CF3-CHCl-O- CFH2-O-
CF2H (CF3)2
Type Halogenated Ether Ether
Molecular weight 197.4 184.5 187.0
Sp.gr. 1.86 1.50
Preservative Thymal Not required Not required
Reaction
Soda lime Yes No Yes
U.V. Light Yes No
Metal Yes No No
Boiling point C@ 760 mm 50.2 48.5
Hg
-Vaplour pressure (mm hg) 243, 32% 239, 31%
 MAC OF COMMONLY USED INHALANTS
Agent Dogs Cats Horses
Halothane 0.86 0.98 0.88
Enflurane 2.2 2.37 2.12
Isoflurane 1.28 1.63 1.31
Methoxyflurane 0.23 0.23 -
Nitrous oxide 188.0 255.0 -

MODULE-13: MONITORING ANAESTHESIA

Learning objectives

This module deals with

Pre operative patient monitoring

History
Physical and Clinical Examination
Functions of CNS, Cardio vascular, Pulmonary during anaesthesia monitoring

INTRODUCTION

Pre, intra and post operative monitoring are most important for the final out
come of anaesthesia and surgery.
The monitoring procedures are aimed to assess the functions of cardiovalscular,
pulmonary and CNS and body temperature, fluid and electrolyte balances.
Intraoperative monitoring must be carefully done because during this stage the
anaesthetic drug will act on various compensatory mechanisms and surgery
will be having its effects on physiology and anatomy of the patient (See Table -
1 and Table - 2 for parameters).

TABLE 1

Normal physiological, cardiovascular, respiratory and hematobiochemical

parameters of domestic animals (Dog, cat, horse and cattle)
 Parameters Dogs Cats Horses Cattle
Rect. Temp 0C 37.5 - 39.2 37.8 - 39.2 37 - 38 38 - 39
Heart rate/min 70 - 110 115 - 200 35 - 60 70 - 120
Cardiac output ml/kg 100 - 200 120 30 - 45 80 - 240
Blood vol.ml/kg 75 - 90 47 - 66 65 - 70 60 - 100
Blood pressure mm of Hg
Systolic 120 - 140 120 - 140 90 - 130 120 - 150
Diastolic 80 - 100 80 - 100 65 - 85 75 - 100
Mean 100 - 110 100 - 110 85 - 120 90 - 120
Resp. rate/min 10 - 30 24 - 42 8 - 20 15 - 35
Tidal volume ml/kg
Minute volume ml/dkg/min 170 - 350 200 - 350 150 - 600
PaO2 mm Hg >100 >100 85 - 90 80 - 110
PaCO2 mm Hg 28 - 49 35 - 49 38 - 40 30 - 50
pH 7.27 - 7.46 7.25 - 7.43 7.40 - 7.45 7.34 - 7.45
HCO3 mmol/lit 20 - 25 17 - 22 24 - 32 20 - 28
Hb g/dl 14 - 17.5 8 - 15 11 - 19 8 - 16
RBC x 10 cu.mm 10 7
WBC x 10 cu.mm 9 - 13 10 - 15 5.5 - 12.5 7 - 10
N% 65 - 70 55 - 60 50 - 60 25 - 30
L% 20 - 25 30 - 35 30 - 40 60 - 65
E% 2-5 2-5 2-5 2-5
M% 5 5 5-6 5
B% <1 <1 <1 <1
PCV % 40 - 55 25 - 45 32 - 52 24 - 46
ESR mm/hr 1-5 7 - 27 2 - 12 2-4
T.S. Protein g/dl 6 - 7.8 6 - 7.5 6 - 8.5 6.7 - 7.5
Albumin g/L 26 - 37 30 - 35.5
Globulin g/L 26.4 - 40.4 30 - 34.8
Fibrinogen mg/ml 200 - 400 50 - 30 400 300 - 700
Blood glucose mg/ml 65 - 118 70 - 110 75 - 115 45 - 75
BUN mg/ml 10 - 28 20 - 30 10 - 25 25 - 30
Creatinine mg/ml 0.44 - 1.32 0.7 - 1.59 1.0 - 2.4 0.84 - 1.77
Total cholesterol mmol/l 3.5 - 6.99 2.46 - 3.37 1.94 - 3.89 2.07 - 3.11
ALT (GPT) IU/L 21 - 102 6 - 83 3 - 23 14 - 30
AST (GOT) IU/L 23 - 66 26 - 43 226 - 366 78 - 132
Lactate dehydrogenase IU/L 45 - 233 63 - 273 100 - 412 692 - 445
Creatinine kinase IU/L 14 - 460 100 - 850 97 - 188 150 - 450
Sorbitol dehydrogenase IU/L 4 - 20 6 - 30
Sodium mEq/L 130 - 143
Chloride mEq/L 98 - 109
Potassium mmol/L 4.37 - 5.35 4 - 4.5 2.2 - 4.1 3.9 - 5.8
Calcium mg/L 10.3 - 13.3
Icterus index,unit 2-5 2-5 5 - 20 5 - 15
Bile acids umol/L 0-5 0-5 5 - 28 20 - 80
Bilirubin mmol/L (total) 1.71 - 8.55 2.57 - 8.55 7.1 - 34.2 0.17 - 8.55
Cortisol nmol/L 27 - 188 9 - 71 36 - 81 17 +/-2
TABLE 2

Normal physiological, cardiovascular, respiratory and haematobiochemical

parameters of domestic animals (Sheep, goat and pig)

Parameters sheep goat pig

Rec. temperature 37 - 40 38 - 40 38 - 40
Heart rate/min 70 - 130 70 - 130 60 - 200
Cardiac output ml/kg 110 - 160 60 - 230 66 - 184
Blood vol. ml/kg 55 - 70 55 - 90 50 - 100
Blood pressure mm Hg
Systolic 80 - 120 80 - 120 80 - 120
Diastolic 60 - 80 60 - 80 60 - 80
Mean 80 - 110 90 - 120 75 - 100
Resp.rate/min 15 - 40 15 - 25 10 - 45
Tidal vol.ml/kg 7-8 7-8 11
Minute vol.ml/kg/min 100 - 133 300 - 400
PaO2 mm Hg 75 - 100 85 - 95 75 - 80
PaCO2 mm Hg 30 - 40 33 - 38 30 - 40
Ph 7.43 - 7.53 7.42 - 7.48 7.38 - 7.50
Bicarboante mmol/L 21 - 28 24 - 27
Hb g/dl 8 - 16 8 - 14 10 - 16
RBC x / cumm 11 7
WBC x /cu.mm 7 - 10 8 - 12 15 - 122
N% 25 - 30 35 - 40 30 - 35
L% 60 - 65 50 - 55 55 - 60
M% 5 5 5-6
E% 2-5 2-5 2-5
B% <1 <1 <1
PCV % 30 - 46 20 - 38 32 - 50
T.S. Protein g/dl 6-8 6.5 - 7.5 6.7 - 7.5
Albumin g/L 24 - 30 27 - 39 79 - 89
Globulin g/L 35 - 57 27 - 49 52 - 64
Fibrinogen mg/ml 100 - 500 100 - 400 100 - 500
Blood glucose mg/dl 50 - 80 50 - 75 85 - 150
BUN mg/dl 8 - 20 10 - 20 10 - 30
Creatinine mg/ml 1.6 - 1.68 0.884 - 1.59 1.41 - 1.50
T.cholesterol mg/dl 1.35 - 1.97 2.07 - 3.37 0.93 - 1.40
ALT (GPT) IU/L 24 - 83 31 - 58
AST (GOT) IU/L 167 - 513 32 - 84
Lactate dehydrogenase IU/L 238 - 440 123 - 392 380 - 634
Potassium mmol/L 3.9 - 5.4 3.5 - 6.7 4.4 - 6.7
Icterus index (unit) 2-5 2-5 2-5
Total Bilirubin mmol/I 1.71 - 8.55 0 - .71 0 - 1.71
Cortisol nmol/L 62+/-10 65+/-8 82+/-3
PRE OPERATIVE PATIENT MONITORING--

Preoperative assessment of the patient is done for the safe administration and
maintenance of anaesthesia.
It will help in tailoring a suitable anaesthetic regimen suitable for the patient.
The importance of preoperative assessment
o To prepare the patient for safe administration of anaesthesia
o To assess the cardiovascular, pulmonary, hepatic, renal functions and
haemato biochemical and electrolyte balances (eg. In diabetic patients
half of the insulin dose is administered after stabilization).

HISTORY

Identification

Identification includes the details of species, breed, sex, age and other
identification marks.

Main complaint

The main complaint is detected to find out whether the disease condition will
interfere with the normal anaesthetic practice and to tailor suitable anaesthetic
regimen.

History of the present illness

Details of the duration of illness, clinical signs and severity of illness are
collected.

Previous medical history

This includes the collection of detils regarding the previous illness, medication,
vaccination, deworming, anaesthetics administered, poisoning, application of
cetoparasiticide etc., (e.g thiopentone is used as induction agent in patients with
the history of epilepsy, horse that suffered from myocarditis will be an
anaesthetic risk patient.

PHYSICAL AND CLINICAL EXAMINATION

Physically examination includes general body condition, palpatin, percussion,

auscultation, measurement of heart, pulse and respiratory rates, examination of
lymph nodes, rectal temperature, appearance of the mucous membrane, reflex
status, integument, location of the lesion and weight of the animal.
 Weight calculation
o Horse = (Heart girth cm- 63.7)/0.38 = body weight in Kg.

Systemic examination

Systemic examination includes the assessment of cardiovascular, pulmonary,

hepatic, renal gastrointestinal, central nervous system, endocrine and
musculoskeletal functions.

Presurgical laboratory examination

It includes the determination of a complete blood count and total plasma

protein.

Further tests-- Includes ECG, X-rays and other special examinations.

INDIRECT MONITORING

Indirect monitoring of CNS function is assessed by the reflex status. The reflex
status is modified by the stages of anaesthesia, drugs used and cerebral blood
flow.
The following reflexes are assessed
o Pedal reflex
o Palpebral reflex
o Corneal reflex
o Lacrimation
o Yawning
o Swallowing reflex
o Laryngeal reflex
o Anal reflex
o Pupillary reflex
o Eyeball position
o Hearing sense

PEDAL REFLEX

This reflex is elicited by applying firm pressure on the interdigital skin in dogs
and cats, squeezing the claws to gather in cattle and swains and firm pressure
on the pastern on horses.
This relfex is abolished in stage III anaesthesia.
Pedal reflex is reliable in barbiturate anaesthesia to assess the depth of
anaesthesia, where as with halogenated inhalants it disappears even in the light
plane of anaesthesia.

PALPEBRAL REFLEX
 Tapping the skin at the medial canthus or running the finger along the
eyelashes stimulates this reflex.
It is abolished in the light plane of anaesthesia in dogs where as in horses
sluggish response can be noticed even at surgical plane of anaesthesia when
inhalants are used.
Palpebral reflex is not abolished during ketamine anaesthesia

CORNEAL REFLEX

This reflex is stimulated by gentle palpation of the cornes on the lateral aspect.
The response is observed by the closure of eyelids.
In horses absence of corneal reflex indicates deep plane of anaesthesia, in dogs
its not reliable and in cattleit may be abolished by repeated stimulation.
Corneal reflex is not abolished during ketamine anaesthesia.

LACRIMATION AND YAWNING

Lacrimation

In horses and cattle lacrimation is reduced during deep plane of anaesthesia,

leading to drying of cornea. It may result in keratitis and ulceration. Sterile
mineral oil or plain eye ointment must be instilled to prevent corneal ulcer.

Yawning

Dogs under light plane of anaesthesia yawn when the mouth is opened.

SWALLOWING AND LARYNGEAL REFLEX

Swallowing reflex

This reflex disappears at the light plane of anaesthesia with exception of young
foals. This reflex is protected in ketamine anaesthesia.

Laryngeal reflex

This reflex is abolished in the light plane anaesthesia except with ketamine
induction. In cats local anaesthetic is sprayed on the larynx to prevent laryngeal
spasm before intubation.

ANAL REFLEX
 This reflex is abolished in the middle of III stage of anaesthesia in dogs and
cats.
In horses it is abolished soon after induction with ketamine.
This reflex is elicited by sudden gentle manipulation of the anus and the
response will be sphincter contraction.

PUPILLARY REFLEX

In general the pupil in unpremedicated animals will dialate during early

excitement phase and then constricts progressively upto surgical anaesthesia.
Again the pulil will dialate as the animal enters into the IV stage of anaesthesia
(progressive medullary paralysis) followed by respiratory and cardiac arrest.
Premedicants alter the papillary reflex.
E.g. Atropine induces pupillary dialatation and narcotics induce constriction in
dogs.

EYEBALL POSITION

The position of eyeball depends on the species and the anaesthetic used.
In small animals the eyeball rotates medially and ventrally in the early stages
and then centrally placed at plane I surgical anaesthesia when inhalants like
halothane or isoflurance is used.
In horses under halothane anaesthesia nystagmus is common during light plane
of anaesthesia and it is centrally placed at the surgical plane of anaesthesia.
In ruminants the eyeball rotates ventrally in light plane of anaesthesia, then
gradually rotates dorsally and finally fix to the central position.

OTHER REFLEXES

Muscle relaxation

It will be modified with the use of anaesthetics and muscle relaxants.

In small animals the jaw tone is used as the criteria of muscle relaxation and
anaesthetic dept.

Hearing sense

It is the last sense to disappear during induction and the first sense to reappear
during recovery.

ELECTROENCEPHALOGRAPH
 The normal EEG pattern is low voltage high frequency activity in the activated
state of brain.
During cerebral hypoxia, hypoglycemia, hypothermia, hyponatremia and at
excessive depth of anaesthesia it becomes high voltage and low frequency.
Then it become isoelectric (burst suppression) as the condition worsened and
finally becomes complete inactive.
Intracranial pressure also provides valuable information regarding the
cardiovascular and pulmonary system and underlying disease.

Cardiovascular Functions- HEART RATE

Heart rate can be monitored by using stethoscope, electronic stethoscope,

oesophageal stethoscope, electronic heart rate meters, elecrocardiography and
Doppler blood flow detector.
Heart rates below 50 to 60 bpm in dogs and cats, 25 bpm in horses and
ruminants is considered to be low heart rate.
Heart rate above 250bpm in dogs, 300 bpm in cats, 75 bpm in horses and
ruminants are considered as high heart rate.
The alteration in heart rate must be simultaneously compared with cardiac
output and blood pressure.

BRADYCARDIA

Bradycardia may arise due to

o Excessive depth of anaesthesia
o Excessive vagal tone (often increased by intubation vasovagal reflex and
traction of abdominal organs)
o Terminal hypoxia
o Endogenous and exogenous toxaemias
o Conduction disturbances in myocardium
o Hyperkalaemia
o Hypothyroidism

Treatment

o Administration of atropine or glycopyrrolate.

o Dopamine 2.5 to 20ug/kg/min (40 to 200 mg in 250 to 500 ml of 5%
dextrose or saline )I.V.
o Dobutamine 2.5 to 20 ug/kg/min (20 to 200 mg in 250 to 500 ml of 5%
dextrose or saline)I.V.
o Mephenteramine 0.1 to 0.75 mg/kg I.V. duration 15 to 30 minutes
o Ephedrine 0.05 to 0.5 mg/kg I.V. duration 15 to 30 minutes.
o Isoproterenol 5 to 10 ug/kg/min (0.4 ti 1.0 mg in 250 to 500 ml of 5%
dextrose or saline )I.V.

TACHYCARDIA
 Tachycardia m ay arise due to
o Light level of anaesthesia
o Hypovolaemia
o Hypoxia
o Hypercarbia
o Hyperthyroidism
Normally pulse rate may either be equal or slightly deficit of heart rate because
all the contraction may not produce palpable effective wave and waves may
overlap.
The abnormal conditions which causes deficit of pulse rates are
o Premature contraction,
o Variable diastolic ventricular filling
o Electromechanical dissociation of heart.

HEART RHYTHM

Supraventricular and ventricular ectopic pacemaker activities are common

during general anaesthesia. The other arrhythmia are sinus bradycardia,
tachycardia and atrioventricular conduction block and all these conditions may
response to the treatment suggested for bradycadia.
Other forms of arrhythmia
o Premature atrial contraction
o Premature ventricular contraction
o Pacemaker actrivity
o Bundle branch blocks
Premature ventricular contraction may progressively lead to ventricular
tachycardia and fibrillation.
The atrial and ventricular premature contraction may be caused by
o Too light level of anaesthesia (due to the release of catecholamines) or
due to deep plane or anaesthesia (due to hypoxia and hypercapnia)
o Hypoxia and hypercapnia
o Hypovolaemia and hypotension
o Exogenous catecholamine therapy
o Digitalis toxicity potentiated by hypokalemia
o Hypokalemia potentiated by respiratory or metablic alkalosis or insulin
therapy
o Hypercalcemia potentiated by respiratory acidosis
o Anaesthetics sensitizing the myocardium for the actions of
catecholamine activity (halothane and xylazine)
o Endocarditis and myocarditis
o Endocardial stimulation by the catheters or epicardial stimulation by the
tubes or surgery
 o High preload or afterload
o Severe hypothermia
o End stages of visceral organs function
o Increased intracranial pressure and intracranial diseases
If the premature ventricular contraction is persistent with heart rate exceeding
180 to 200 the following treatments must immediately be adopted.
o Check the oxygen supply and maximize the inspired oxygen level. (10
ml/kg/min in circle system and 200 ml/kg/min in nonbreathing system)
o Institute intermittent positive pressure ventilation
o Start fluid aministration
o Discontinue the agents which results or lower the threshold for the onset
of arrhythmia.
o Administer anyone of the following.
Lignocaine 1 to 5 mg/kg I.V.
Procainamide 1 to 5 mg/kg I.V
Propranolon 0.05 to 0.3 mg/kg I.V
Verapamil 0.05 to 0.15 mg/kg I.V
The other ECTG abnormalities are
o Change in the rhythm
o Change in the configuration of PQRST
o Absence of P wave or shortened P R interval (Right ventricular
hypertrophy, Bundle branch block and ventricular premature contraction
all will show bizarre locking ORS
o Abnormal T wave (tent shaped) due to hyperkalemia and hypoxia
o Depressedor elevatedor slurred S T segment due to myocardial
hypoxia.

ECG lead placement in anaesthetized animal (LEAD II)

Small animals

RA Right arm or any where on the body rostral to the heart

LL Left hind leg or any where on the body caudal to the heart
LA Left arm or any where on the body (ground)

Large animals

RA Right arm or low on the chest towards the sternum (negative pole)
LL Left hind leg or on the chest above the spine of scapula (Positive pole)
LA Left arm or on the neck (ground)
VENTRICULAR PERFORMANCE
 Ventricular performance is the contractile force of the heart, and can be
assessed by the loudness on auscultation using ordinary stethoscope or
oesophageal stethoscope or heart sound amplifier.
Diminished heart sound is due to hyproventilation, myocardial weakness,
hypoxia, anaesthetics, severe metabolic disturbances, endo and exogenous
foxins, execessive or insufficient end-diastolic filling volume.
Ventricular performance can be improved by
o Dopamine 2.5 to 20 ug/kg/min (40 to 200 mg in 250 to 500 ml of 5%
dexotrose or saline)
o Dobutamine 2.5 to 20 ug/kg/min (40 to 250 to 500 ml of 5% dextrose or
saline)
o Mephenteramine 0.1 to 0.75 mg/kg/I.V
o Calcium chloride 10% 0.1 mg/kg. I.V.
o Digitalis
o Amrinone (new inotropic agent ) 0.75 to 3 mg/kg I.V (peak effect in 10
minutes and the duration is 30 to 120 minutes)

CARDIAC OUTPUT

Cardiac output can be measured by dye dilution technique or thermodilution

technique.
Indocyanian green a dye is injected into the right atrium at a known
concentration.
The change in the concentration at the down stream (pulmonary artery or aorta)
is measured and the cardiac output is calculated.
In thermodilution technique iced saline or saline in room temperature is
administered in the right atrium and change in the temperature is assesses at
downstream using thermodilution catheter located in the pulmonary artery.
The thermodilution catheter is inserted into the right atrium through jugular
vein using fluoroscopy or blindly (flow directional balloon catheters are used
for blind methods).
The causes for reduced cardiac output
o Insufficient venous return
o Ventricular restrictive diseases (hypertrophy, pericardial tamponade or
pericardial fibrosis)
o Decreased contractility
o Excessive bradycardiaand arrhythmis
o Regurgitation and retrograde flow
o Stnosis
o Positive inotropic drugs are administered to correct the cardiac output.

PERIPHERAL PERFUSION

It is assessed by the colour of the mucous membrane and the capillary refill
time.
The normal capillary refill time is less than 2 seconds.
 Pale mucous membrane and prolonged refill time are due to reduction in
perfusion.
The other methods to assess the peripheral perfusion is by the use of ultrasonic
Doppler, electromagnetic flow probes, radionuclide imagery, nuclear magnetic
resonance and position emission tomography.
The reasons for reduced peripheral perfusion
o Stress induced increase in sympathetic tone
o Hypovolemia
o Low cardiac output
o Fear and pain
o Exogenous alpha Receptor agonist catecholamine therapy.

BLOOD PRESSURE

Blood pressure is one of the important parameter to be monitored during

anaesthesia because adequate blood pressure is needed to perfuse the brain and
heart.
A minimum 50 to 60 mm of Hg mean arterial blood pressure (MAP) is to be
maintained for coronary and cerebral perfusion.
Arterial blood pressure can be measured by
o Direct and Indirect techniques in animals.
Indirect technique
o In indirect technique a cuff is placed snugly around the limb or tail and
inflacted until the blood flow is occluded.
o The extraluminal pressure just to occlude the blow is considered as the
pressure, which is above the systolic pressure. As the cuff pressure is
reduced the flow will restore.
o The flow can be assessed by direct palpation of the artery (only for
systolic pressure) or by auscultation for Korotkoff sounds.
o The first sound represents systolic pressure and the muffing or
disappearance of the sound represents the diastolic pressure.
o Pediatric cuffs are well suited for veterinary use.
o Cuff Placement
Dogs above the elbow
Horses Coceygeal artery
Sheep and goats above the elbow or around the tibia
Direct technique
o direct method of blood pressure measurement is done by catheterization
of a suitable artery and connecting it to an aneroid manometer to assess
the mean arterial pressure.
o A transducer is placed in machines to record both diastolic and systolic
pressure.
o Catheterization of artery
Dogs femoral artery, dorso metatarsal artery,l lingual artery
Horses Facial artery, metatarsal artery, common digital artery
Cattle Middle coccygeal artery, median auricular artery
 Sheep & goat Auricular artery
Cat Superficial musculocutaneous branch of femoral artery.
o The normal systolic, diastolic and mean arterial pressure is 100 to 160,
60 to 100 and 80 to 120 mm of Hg respectively. Systolic pressure below
80 and mean arterial pressure below 60 mm of Hg are considered as
hypotension and will result in poor cerebral and coronary perfusion.
o The mean arterial pressure can be calculated from systolic and diastolic
pressure using the formula:
o MAP in mm of Hg + Diastolic + ((Systolic
diastolic)/3)
o The mean blood pressure is not the half of the total of systolic and
diastolic pressure. The MAP is always close to the diastolic pressure.
The difference between the systolic and diastolic pressure is called as
pulse pressure.

TREATMENT OF HYPOTENSION

Discontinue the anaesthetics and adjuncts, which induces hypotension and use
the agents like diazepam and ketamine.
Lactated Ringers 10 to 40 ml/kg is administered over a period of 10 to 30
minutes.
Multielectrolyte sodium containing crystalloid replacement solutions can be
administered routinely at the rate of 10 ml/kg/hr plus 2 to 3 times the volume of
estimated blood loss. During major procedures like thoracotomy, fracture
repair and laparotomy it can be increasedupto 20 ml/kg.
During anemia and hypoproteinemia crystalloid solutions are not administered.
If the PCV is less than 20% blood is indicated and if the total serum protein is
less than 3 to 3.5 g/dl further volume replacementis done only by plasma or
dextran.
Sympathomimetic drugs are used in extreme hypotension with caution and
continuous monitoring as they may induce cardiac arrhythmia.
(See Anaesthetic emergenices)

CENTRAL VENOUS PRESSURE

Central venous pressure (CVP) is the luminal pressure of the intra thoracic
anterior vena cava or right atrium.
The central venous catheters are positioned through percutaneous
catheterization of jugular vein.
The zero level of the manometer is maintained at the heart level.
The nomal CVP is 0 to 10 cm of H2O in small animals, t to 15 cm of H2O in
awake horses, 25 to 35 cm of H2O in anaesthetized recumbent horses and 5 to
10 cm ofH2O in cattle, sheep and goats.
Increase in CVP could be noticed in reduced cardiac output vascconstriction
and hypervolemia.
 CVP decreases during vasodilatation, hypovolemia and obstruction to venous
return.
Fluid therapy is indicated when increase in CVP is noticed with heart failure.

PULMONARY ARTERY PRESSURE AND WEDGE PRESSURE

Pulmonary artery and wedge pressures indicate the functional capacity of the
left side of the heart.
A flow directional balloon catheter is inserted into the jugular vein to pass the
right atrium, right ventricle to reach the pulmonary artery bifurcation.
Pulmonary wedge pressure is recorded when the balloon is in inflated condition
and pulmonary artery pressure isrecorded when the balloon is in deflated
condition.
Normal pulmonary artery systolic and diastolic pressures are 20 to 40 mm Hg
and 5 to 10 mm Hg respectively.
The pulmonary wedge pressure is 3 to 8 mm Hg. Pulmonary artery diastolic
pressure will almost be equal to wedge pressure.
Increase in pulmonary artery and wedge pressure is observed during positive
pressure ventilation, mitral insufficiency and excess pulmonary venous
pressure.
During spontaneous ventilation the pulmonary artery and wedge pressure will
decrease.

Pulmonary Functions-----RESPIRATORY RATE

Carbon dioxide is the primary chemical stimulant of respiratory centers to

maintain normal respiratory pattern.
Hypocapnia in anaesthetized patients may resulting apnea.
In anaesthetized patients each respiration must be long and large to satisfy the
ventilatory requirement and oxygen demand.

BRADYPNEA

The reasons for bradypnea are

Cerebral oedema, neoplasia or haematoma.
Anaesthetic depression and hypoxia
Medullary dysfunction
The altered breathing patterns are
o Apnea due to medullary dysfunction
o Diaphargmatic breathing: during respiration the diaphragmatic
component precedes and thoracic component.
o Cheyne Stokes breathing: It is characterized by cyclic hyperventilation
and hypoventilation due to the delay in medullary response to changing
carbon dioxide tension.
o Biots breathing: characterized by cyclic hypoventilation and apnea and
this pattern is also a sign of serous medullary disturbance.
 oApneustic breathing: This pattern is associatedwithbrain stem disease
and is commonly seen in ketamine anaesthesia.
o Agnoal gasps: Characterized by periodic retraction of the hyoid
apparatus and gasping through the mouth may or may not associate with
diaphragmatic contraction.
During surgical procedures apnea may develop due to
o Spinal cord oedema secondary to CSF tapping
o Injection of contrast agents for myelography
o Due to neuromuscular blocking agents
o Deep anaesthesia.

TACHYPNEA

Elevated respiratory rate (tachypnea) may be associated with normoventilation

or hypoventilation.
Reasons for tachypnea
o Hypercapnia
o Hypoxia
o Hypotension
o Hyperthermia
o Too light level of anaesthesia inducestachypnea and hyperventilation
o Too deep anaesthesia induces tachypnea and hypoventilation
o Airway obstruction resultsiln tachypnea and hypoventilation
o Pneumothorax, hydrothorax, chylothorax, haemothorax and
diaphragmatic hernia
o Space occupying abdominal lesions such as gastric/intestinal tympany,
ascitis, neoplastic mass, gravid uterus and pyometra
o Atelectasis and airway collapse
o Anesthetic drugs like ketamine, diazepam and certain narcotics.

Treatment

o Proper intubation
o Articifial ventilation oncein 30 seconds in case of apnea
o Institution of intermittent positive pressure ventilation
o Sighing of the patient once every minute (squeezing the rebreathing bag)

NATURE OF VENTILATORY EFFORT

The normal respiratory effort is smooth, easy, regular and comprised of

thoracic and diaphragmatic movements.
The abnormal ventilatory efforts are
o Exaggerated breathing effort- indicative of respiratory stimulation.
o Stertorous- indicative of upper airway obstruction
o Wheezing- indicative of lower airway narrowing
o Crepitation- indicative of fluid bubbling sound
 o Intercostal retraction during inspiration- indicative of upper airway
obstruction
o Predominance of diaphragmatic component during inspiration-indicative
of deep anaesthesia.

COLOR OF MUCOUS MEMBRANE

Cyanosis indicates severe hypoxemia.

If cyanosisis noticed during anaesthesia immediately the oxygen supply must
be checked for the correct delivery.
The oxygen is supplied at the rate of 10 ml/kg/min in circle system and 20
ml/kg/min in nonrebreathing system.
The other reasons for cyanosis are shock, hypothermia, cardiac arrest and
intrathoracic lesions.
Drugs like acetaminophen induces cyanosis in cats and benzocaine induces
cyanosis in dogs and cats.

VENTILOMETRY

Measurement of ventilation volume is ventilometry.

Visual observation suggests the volume roughly.
Ventilometers are fitted on the expiratory side of the breathing circuit will
indicate the tidal and minute volume.
The normal ventilation is 150 to 250 ml/kg/min. Minute volume below 100
ml.kg/min is considered as hypoventilation and above 300 ml/kg/min as
hyperventilation.

BLOOD GAS

Arterial blood is collected in 2 ml heparinized syringe with 22 to 25 gauge

needle and the needle is corked or the needle guard is replaced immediately.
The syringe is kept in ice and sends for analysis using blood gas analyzer.

Partial pressure of carbon dioxide (PaCO2)

The normal PaCO2 is 35 to 45 mm Hg.

PaCO2 less than 35 mm Hg indicates hyperventilation.
PaCO2 above 45 mm Hg indicates hypoventilation. PaCO.
PaCO2 above 60 mm Hg indicates severe respiratory acidosis
PaCO2 less than 20mm Hg indicates severe respiratory alkalosis and decreased
cerebral blood flow
PvCO2 (venous) will be 2 to 5 mm Hg greater than PaCO2.
PaCO2 indicates the ventilatory status of the patient
PaCO2 level can be used to calculate the alveolar partial pressure of oxygen
(PAO2) using the formula
o PAO2 = FiO2 x ( P B P H20 ) PaCO2 / R
 FI02 Fractional concentration of inspired oxygen (normal air contains 21%
oxygen hence it is 0.21.
PB Barometric pressure (normally 760 mm Hg at sea level) given in the
blood gas report.
PH20 Water vapour pressure (47 mm Hg when the air is fully saturated at
37oC) given in the blood gas report.
R - Respiratory quotient, it is a constant, which is equal to 0.8 (ratio of carbon
dioxide production to oxygen consumption)

Partial pressure of oxygen (PaO2)

The normal PaO2 is 90 to 100 mm Hg.

Pa02 less than 60 mm Hg indicates hypoxia and hypoventilation
Animals breathing enriched oxygen mixture will be having higher Pa02
Pa02 indicates the oxygenating capability of the lung

METABOLIC ACIDOSIS

The pH will indicate the metabolic acidosis and is attributed to the lactic
acidosis secondary to inadequate tissue perfusion due to vasoconstriction,
hypotension, hyperthermia or infusion of acidotic fluids.
Bicarbonate is administered only for the patients having bicarbonate deficit, not
for all acidotic conditions.
The amount of bicarbonate in mEq to be administered is calculated as base or
bicarbonate deficit x 0.3 x body weight in kg (approximately 1 to 5 mEg/kg).
The commercially available bicarbonate powder is equal to 12 mEq per grams.
Bicarbonate solution must be administered slowly because rapid administration
may cause alkalemia, hypokalemia, decreased ionized calcium, hypotension,
nausea, vomiting, collapse and even cardiac arrest.

TEMPERATURE

Recording body temperature is important in anaesthetized patients as it

indicates the systemic function.
The temperature can be recorded at deep rectum, cervical oesphagus, pharynx
and under the tongue.
During anaesthesia drop in temperature could be noticed due to the reduction in
metabolic rate.
Premedicants like acepromazine deplete the catecholamine in the
thermoregulatory center and render the animal to pick up the environmental
temperlature.(See hypothermia and hyperthermia in Anaesthetic complication)

URINE OUTPUT

It is an indirect assessment of visceral perfusion. Urinary catheters are placed

aseptically and the urine is collected.
 The normal expected urine output in anaesthetized animals is 1 to 2 ml/kg/hr.
If the urine output is reduced lactated Ringers is administered at the rate of 20
to 40 ml/kg rapidly to induce diuresis.
The other agents administered to induce diuresis are
o Furosemide 5 mg/kg diuresis occurs in 5 to 10 minutes
o Glucose, Mannitol (0.5 g/kg over 20 to 30 minutes) as infusion
o Dopamine 1 to 5 g/kg/min.

MODULE-14-

Anaesthetic Emmergencies & its management -

REASONS FOR ANAESTHETIC EMERGENCIES

Human error
o Not familiar with the equipment and anaesthetic drug and its action,
miscalculation of dose, incorrect route of administration and wrong
medications.
Equipment problems
o Failure to deliver oxygen, empty cylinders, misconnected gas lines and
kinked or plugged endotracheal tubes.
Ventilatory problems
o Hypoventilation due to anaesthetic over dose, hyperventilation due to
inadequate anaesthesia and ventilatory depression.
Circulatory problems
o Hypotension, bradycardia, tachycardia and shock.

BRADYCARDIA
 Bradycardia may arise due to
o Excessive depth of anaesthesia
o Excessive vagal tone (often increased by intubation vasovagal reflex and
traction of abdominal organs)
o Terminal hypoxia
o Endogenous and exogenous toxaemias
o Conduction disturbances in myocardium
o Hyperkalaemia
o Hypothyroidism

Treatment

o Administration of atropine or glycopyrrolate.

o Dopamine 2.5 to 20ug/kg/min (40 to 200 mg in 250 to 500 ml of 5%
dextrose or saline )I.V.
o Dobutamine 2.5 to 20 ug/kg/min (20 to 200 mg in 250 to 500 ml of 5%
dextrose or saline)I.V.
o Mephenteramine 0.1 to 0.75 mg/kg I.V. duration 15 to 30 minutes
o Ephedrine 0.05 to 0.5 mg/kg I.V. duration 15 to 30 minutes.
o Isoproterenol 5 to 10 ug/kg/min (0.4 ti 1.0 mg in 250 to 500 ml of 5%
dextrose or saline )I.V.

Reasons for intraoperative bradycardia

Due to increase in vagal tone

o Difficulty in intubation
o Deep abdominal surgery
o Intraocular surgery
o Neck and thoracic surgery
o Effect of anaesthetics
o Premedication with atropine or glycopyrrolate will control this
o condition.
Non vagal bradycardia
o Excessive depth of anaesthesia
o Hypoxia
o Hypothermia
o Hyperkalemia

TACHYCARDIA

Tachycardia may arise due to

o Light level of anaesthesia
o Hypovolaemia
o Hypoxia
o Hypercapnia
o Hyperthyroidism
 Normally pulse rate may either be equal or slightly deficit of heart rate because
all the contraction may not produce palpable effective wave and waves may
overlap.
The abnormal conditions which causes deficit of pulse rates are
o Premature contraction,
o Variable diastolic ventricular filling
o Electromechanical dissociation of heart.
Heart rate above 180 per minute in dogs and above 200 per minute in cats are
considered as tachycardia.

SHOCK

Shock is defined as inadequate blood flow to the vital organs or the inability of
the body cells to metabolize nutrients normally.
The tissue perfusion depends on the cardiac function, circulatory volume and
integrity of vascular function.
Shock can be classified as
o Hypovolemic shock
o Cardiogenic shock
o Vasculogenic shock
o Hyperdynamic shock
o Hypodynamic shock

HYPOVOLEMIC SHOCK

Causes

Due to inadequate volume of fluids or blood due to the loss of whole blood,
plasma or loss of water and electrolytes
Loss of blood in accident
Loss of polasma protein into inflamed body cavities
Loss of fluid and electrolytes in diarrhea

Symptoms

Depressed, dull and lack luster/lusterless eyes

Pale or white or blue mucous membrane
Reduced capillary refill time
Cold extremities
Tachycardia
Fast and weak pulse
Elevated respiratory rate
 Reduced body temperature

CARDIOGENIC SHOCK

Causes

Occurs when the heart fails to pump adequate blood to maintain perfusion.
Failure could be due to reduced venous filling and reduced cardiac output. This
condition is common in small animals.
Cardiac tamponade
Rupture of chordae tendinae
Toxic myocardial depression
Cardiac arrhythmia
Severe prolonged systemic vascular resistance

Symptoms

Depressed, dull and lack luster/lusterless eyes

Pale or white or blue mucous membrane
Reduced capillary refill time
Cold extremities
Tachycardia
Fast and weak pulse
Elevated respiratory rate
Reduced body temperature
Distended pulsating peripheral veins
Hepatomagaly
Peripheral oedema
Cardiac dysrhythmia
Heart murmurs

VASCULOGENIC SHOCK

Causes
 The vessels supplying the blood to the tissues are affected and the perfusion is
reduced
Arteriolar constriction
Prolonged sympathetic stimulation
Vasomotor paralysis due to head injuries
Endotoxic and septic shock can also be categorized under vasculogenic shock
as the toxins produce vasodilation due to the release of histamine, bradykinin
and prostoglandins.

HYPERDYNAMIC SHOCK

Causes

An early stage of septic shock is an example of hyperdynamic shock.

Signs

Stage I

Increase in cardiac output

Decrease in arteriovenous oxygen difference
Decrease in systemic vascular resistance
Blood pressure may be normal or reduced
Oxygen utilization at cellular level is reduced

Stage 2

Cardiac output may be normal

Hypotension
Respiratory acidosis with metabolic alkalosis
Elevated heart rate

Stage 3

Reduction in cardiac out put

Elevated heart rate
Increased difference in arteriovenous oxygen level
Increase in systemic vascular resistance
Hypotension
Brick red mucous membrane due to peripheral vasodilation
Pyrexia due to toxins and damaged leukocytes
 HYPODYNAMIC SHOCK

It occurs at the terminal stage of sepsis or during the absorption of toxins. This
can be otherwise called as fourth stage of septic shock.
Hypodynamic shock is common in large animal practice. E.g. terminal stage of
horses with colic and cow with coliform mastitis.

Signs

Myocardial depression
Maldistribution of blood volume
High peripheral resistance
Endothelial damage
Infarcts in vital organs
Acute respiratory failure and hypoxaemia

SIGNS OF CPR

No ausculatatable heart sound

No palpable pulse
Cyanotic mucous membrane
Dilated pupil
No ventilatory attempts or agonal gasps
Unconsciousness
It is really a true emergency condition, which is to be treated immediately
within a period of 2 to 3 minutes.
The basic life support in cardio pulmonary resuscitation(CPR) is the optimal
management of airway(A), Breathing(B) and circulation(C). Otherwise called
as ABC of CPR.

AIRWAY

The head must be immediately extended

If not intubated, intubate the animal immediately.
Examine for the possible obstruction of the airway with food materials or
kinked endotracheal tube
In emergency perform tracheostomy to maintain airway patent
In case of bronchospasm treat the animal with aminophylline 5 mg/kg I.V.

TREATMENT OF CPR
Airway

The head must be immediately extended

If not intubated intubate the animal immediately.
Examine for the possible obstruction of the airway with food materials or
kinked endotracheal tube
In emergency perform tracheostomy to maintain airway patent
In case of bronchospasm treat the animal with aminophylline 5 mg/kg I.V.

Breathing

Institute artificial respiration using rebreathing bag or mechanical ventilators at

the rate of 12 to 20 breaths per minute.
Supply 100% oxygen
Or use Ambu type resuscitation bag (using room air 21% oxygen) or mouth to
endotracheal or mouth to muzzle procedures to maintain breathing
Analeptic agents like doxapram can be administered at the rate of 1 mg/kg I.V.
The other agents are specific alpha 2 antagonist (yohimbine) and opioid pure
antagonists (naloxone) (See premedication).

Circulation

External cardiac massage by chest compression at the rate of 90 to 120 per

minute. In dogs the chest compression can be attempted by placing the hands
on either side of the chest. In cats the forefinger and the thumb is used.
Open cardiac massage is done at the rare of 60 to 100 per minute. If surgery is
performed in the thorax its easy to provide open chest massage. During
abdominal procedures if emergency occurs the thoracic cavity can be entered
through the diaphragm.
Defibrillation - The defibrillation is done using external or internal paddles of
cardiac defibrillators. The power setting depends on the weight of the animals.
In small animals the heart is defibrillated at the rate of 1 to 10 J/kg using
external paddles and 0.1 to 1 J/kg using internal paddles.

DRUGS USED IN CPR

Calcium solutions

Administered as inotropic agent or in hypocalemic agent. (halothane decreases

calcium availability in heart muscles.
It strengthens the myocardial contraction. Dose Calcium chloride 10% solution
at the rate of 0.1 mg/kg I.V, Calcium gluconate 10% solution at the rate of 0.5
mg/kg I.V.

Dobutamine
 It is a sympathomimetic amine, whichstimulates beta 1 and beta 2 adrenergic
receptors and to a lesser extend alpha 1 receptor.
It decreases peripheral vascular resistance and increases cardiac output, blood
pressure and tissue perfusion.
Rapid intravenous administration may cause cardiac dysrhythmias.
Dose 0.25 to 20 g/kg/min in small animals and 0.5 to 2.0 g/kg/min in large
animals (40 to 200 mg in 250 to 500 ml of 5% dextrose or saline).

Ephedrine

It stimulates beta 1, beta 2 and alpha 1 receptors.

The cardiac output and blood pressure are increased.
It is indicated in mild to moderate hypotension.
Dose 0.05 to 0.5 mg/kg I.V in small animals and 0.022 to 0.66 mg/kg I.V in
large animals as a bolus.

Isoproternol

It is a sympathomimetic amine, which stimulates beta 1, beta 2 and adrenergic

receptors located in the heart, bronchialsmooth muscles, skeletal muscle
vasculature and alimentary tract.
It decreases peripheral vascular resistance, diastolic blood pressure and mean
arterial pressure and increases cardiac output and systolic blood pressure.

Epinephrine

It is a sympathomimetic amine that stimulates alpha 1, 2 and beta 2 adrenergic

receptors.
It dilates the vasculature of muscles and constricts cutaneous, mucosal and
renal vasculature.
The systolic, MAP andpulmonary blood pressures are increased following
administration.
It can cause dysrhythmia if administered during halothane anaesthesia.
It is administered at a dose of 5 ml of a 1 in 1000 solution for a 454 kg horse.
In extreme condition it is administered through intracardiac route.

Doxapram (Dopram)

It is a nonspecific analeptic agent used to act on the peripheral chemoreceptors.

Dose. 0.55 mg/kg I.V. to reverse the effect of xylazine it is administered at the
rate of 1.0 mg/kg I.V.

Sodium bicarbonate
 It is a buffer aids in reversing metabolic acidonin. Dose mEq of HCO3 = 0.3 x
base deficit (mEq/L) x Body weight.

Coricosteroids

These group of agents increases the glucose production, induce hypdokalemia

by sodium retention.
They have inotropic effect on the heart and maintain vasomotor response and
suppress the adrenal gland.
Indicated in shock and malignant hyperthermia.

Lignocaine

Indicated in premature ventricular contraction.

Only the epinephrine free preparation is used.
Dose 0.5 to 2 mg/kg in large animals and 1 to 5 mg/kg in small animals
followed by 40 to 60 g/kg/min I.V. It is contraindicated in slow ventricular
rate combined with sinus arrest, sinoatrial block or atrioventricular block.

Module -15 = Neuroleptanalgesia

PHENOTHIAZINE DERIVATIVES

Phenothiazine derivatives

Phenothiazine derivatives are basically three ring structures in which two

benzene rings are linked by a sulphur and nitrogen atom.
The steriochemical model of phenothiazine derivatives is similar to
epinephrine, norepinephrine and dopamine.
They act on the central nervous system by depressing the brain stem and
connections of the cerebral cortex.
These agents increase the dopamine and norepinephrine turn over in the
brain and block the peripheral actions of catecholamines at alpha 1 receptors.
 These agents are weak anticholinergics and have extrapyramidal stimulating
properties.
Acepromazine maleate, triflupromazine hydrochloride, chlorpromazine,
promazine, promethazine and methotrimeprazine are the commonly used
phenothiazines. Among these agents acepromazine, triflupromazine and
chlorpromazine are used in veterinary anaesthesia.

Clinical properties and uses

Produce sedation, general calming and reduction in motor activity

Antagonize dopamine excitatory chemoceptors and suppress vomiting.
At high doses and some times in clinical doses induce extrapyramidal signs
such as rigidity, tremors and catalepsy. Hence contraindicated in patients;
o With the previous history of epilepsy,
o Undergoing myelographic procedures
o With the history of recent intake of organophophorus drugs or toxicity
Pulmonary functions are maintained following the administration of
phenothiazines except slight depression in respiratory rate
Induce urine production due to the suppression of antidiuretic hormone
Animals undergoing intradermal allergic tests should not be administered with
phenothiazines as they are potent antihistaninics
Depletes catecholamines of the thermoregulatory center and render the
animals body temperature susceptible to the changes in the environmental
temperature.
Tranquilization with phenothiazines is contraindicated in animals undergoing
epidural, spinal or segmental anaesthesia. Following induction of regional
anaesthesia there will be vasodilation in the anaesthestised part of the body
and this effect is compensated by the vasoconstriction in the unanaesthetized
parts of the body to maintain cardiac out put. This response is abolished by
the generalized vasodilationinduced by phenothiazines.

Clinical doses of phenothiazine derivatives

CLINICAL DOSES OF PHENOTHIAZINE DERIVATIVES

Drug Dose
Acepromazine Dogs = 0.03 0.05 mg/kg I.V, 0.03 0.05 mg/kg
I.M.
Cats = 0.03 0.05 mg/kg I.V, 0.03 0.1 mg/kg
I.M.
Horses = 0.02 0.05 mg/kg I.V, 0.04 0.09 mg/kg
I.M.
 Cattle = 0.02 0.05 mg/kg i.V, 0.04 0.09 mg/kg
I.M.
Pigs = 0.1 mg/kg I.M.

Chlorpromazine Dogs = 0.55 4.4 mg/kg I.V, 1.1 6.6 mg/kg I.M.
Cats = 0.55 4.4 mg/kg I.V, 2.2 6.6 mg/kg I.M
Horses = 1.1 2.2 mg/kg I.M.
Cattle = 0.2 1.1 mg/kg I.V, 0.2 2.2 mg/kg I.M.
Sheep = 0.55 4.4 mg/kg I.V, 2.2 6.6 mg/kg I.M.
Goats = 0.55 4.4 mg/kg I.V, 2.2 6.6 mg/kg I.M.
Pigs = 1.0 2.0 mg/kg I.M.

Promazine Horses = 0.44 1.1 mg/kg I.V/I.M.

Cattle = 0.44 1.1 mg/kg I.V/I.M.
Goats = 0.44 1.1 mg/kg I.V/I.M.
Sheep = 0.44 1.1 mg/kg I.V/I.M.
Pigs = 0.44 1.1 mg/kg I.V, 0.44 4.0 mg/kg I.M.

Triflupromazine Dogs = 1.00 mg/kg

Module- 16-Acupuncture, Electro-anaesthesia,

Hypothermic anaesthesia

ACUPUNCTURE - INTRODUCTION
 Acupuncture (AP) can be used to obtain pain relief in clinical disorders or as an
alternative or complementary method of inducing pain control during surgical
procedures. AP analgesia (AA) is a misnomer. It should really be called AP
hypoalgesia. It is a pain inhibition phenomenon caused by stimulation of
peripheral nerves via certain AP points.
The degree of pain inhibition may be complete or partial. In vet surgery, the
AA technique, if applied carefully, often is sufficient to allow surgery without
the use of other anaesthetics. Consciousness is retained throughout the
operation but many animals become slightly drowsy (as if slightly sedated)
during and for a short time after AA stimulation. All other sensations (touch,
traction, pressure, tickle etc) and reflexes (to sight or sound stimuli, fear,
traction etc) are intact. AA can be induced by simple AP (manual twirling of
the needles) but it is more common to use electrical stimulation (ES) via the
needles. In this case the technique is called Electro-APanalgesia (EAA).
In emergencies a slight degree of hypo-algesia can be obtained in humans and
animals by heavy digital pressure over the correct AP/nerve points. This
method may have application in time of war or national disasters, when
anaesthetists and anaesthetics may not be available. AA also can be induced by
other stimuli, such as injection or electro-static fields applied to the points.
Since the late 1980s, research on uses of low-power (cold) Laser as an AA
stimulus is ongoing, with some positive results. However, it is too early to
attempt to assess that method.
Stimuli via the AA points are carried in the peripheral sensory nerves to the
spinal cord. They reach the midbrain via the ascending spino-thalamic tracts. In
the midbrain the ascending signals cause release of endorphin, serotonin and
other neurotransmitters which activate a "descending inhibition mechanism"
and prevent the "pain signals" from the surgical area from reaching the cerebral
cortex. Thus, AA can be said to "close" various "pain gates" in the nervous
system. These gates are thought to be located in the spinal cord, thalamus and
possibly other areas. The result is that the human (and, presumably, the animal)
patient can feel the knife, the touch and traction etc but does not "feel pain".
Stimulation-Produced-Analgesia (SPA): Since the 1970s, western researchers,
working independently of the Chinese, found that various types of stimuli
applied indirectly or directly to the nervous system can reduce or abolish
clinical and operative pain. Transcutaneous Electro-Stimulation Analgesia
(TESA) has been used in childbirth in the human female and is somewhat
comparable to EAA. Dorsal Column Stimulation (DCS) of the spinal cord has
been used in intractable pain in humans. ES via electrodes implanted in specific
sites in human or animal brain can induce a high degree of analgesia, usually
involving the entire body. Direct ES of human thalamic or spinal areas can
abolish clinical pain. Vaginal stimulation (electrical or mechanical) can cause
potent whole-body analgesia in rats.

TYPES OF OPERATIONS UNDER AA

 Since the mid 1970s, major surgery has been done in animals under AA as the
sole analgesic agent in many countries in the West. These include France,
Germany, Austria, Belgium, USA, Canada and Australia.
Workers in Eastern countries such as China, Japan, Taiwan etc have used the
method for many years. The animal species involved include horses, mules,
donkeys, cattle, sheep, goats, pigs, monkeys, dogs, cats, rats, cavies, guinea
pigs and mice.
Types of surgery successfully done in animals include:
o caesarean section, ovario-hysterectomy;
o gastric and intestinal surgery;
o nephrectomy;
o removal of mammary and skin tumours;
o surgery of the eye, ear, anal and vaginal region, limbs and teats;
o surgery on the lip, oesophagus, trachea, frontal sinuses;
o rumen;
o navel hernia repair;
o surgery on the bladder and urethra;
o orthopaedic surgery (bones, joints);
o removal of parotid and submaxillary glands;
o castration, orchidopexy, inguinal hernia.
The late Dr. Westermayer's method for reposition of the prolapsed uterus has
been mentioned already, as has AP therapy for the relief of dystocia.

EQUIPMENT AND METHODS OF RESTRAINT FOR AA

Equipment

Most AA is done using electrostimulation (ES) through needles in the correct

points (Electro-AP analgesia = EAA). The choice of points will be discussed
later. Many different types of electrostimulator are on the market. Some are
made in China, others in Japan, USA, Canada, Europe and Australia etc.
The equipment should be strong, portable and battery-operated. It should have
outputs for at least 8 electrodes. There is little standardization of equipment.
Newer models for human use would be adequate for EAA in animals. It is safer
to use models which deliver a bipolar waveform, (+) and (-), at each electrode.
This prevents the development of serious electrolytic lesions which could arise
if a monopolar waveform was used for long periods, as in prolonged surgery.
The Model 71-3 General Purpose Electro-AP Apparatus is suitable for AA as
well as AP therapy. I had 8 teeth extracted and 8 teeth filled under EAA with
the Model 71-3. I used mainly ChiaChe (ST06) plus Earlobe "Dental Analgesia
Point" on the affected side. Needles were inserted 12-20 mm in the points.
Voltage was increased slowly to maximum tolerance (anaesthesia mode, dense-
disperse waveform). Occasionally adjustable waveform at 5-10 Hz was used.
 After 30 minutes of induction, the output was usually at a setting of 4-5 on a 10
point scale. When heavy needle-probing of the gum caused no pain, dentistry
could begin. Dental fillings under EAA were uneventful except in deep root
fillings. If "nerve pain" arose, turning up the voltage usually controlled it.
Extraction was painless or caused minimal pain in 5/8 cases but 3/8 extractions
caused moderate to severe pain but were completed without the use of drug
analgesia. An impacted wisdom-tooth required 10 minutes of very strong
rocking to remove it from its socket. There was rather severe pressure-pain
with that attempt but I was able to tolerate it without asking for another
anaesthetic. My dentist told me that most patients could not have had the tooth
removed unless they had general anaesthesia.
In human patients, Caesarean section has been done in Japan using electro-
static or electromagnetic fields around the hands and feet. The apparatus used
does not appear to have been tested in Europe or America. Childbirth has been
helped in 60-80% of women treated by transcutaneous ES analgesia (TESA) of
the thoraco-lumbo-sacral region. The apparatus used was the Travisens,
available from Dan Sjo Elektronik AB, Box 144-17224, Sundbyberg, Sweden.
TESA does not appear to have been tested in animals.

Restraint for AA in animals

Surgery under AA requires adequate restraint because consciousness and all

sensations and reflexes (except those of pain) are retained.
In large animals, operations under AA may be performed with the animal in the
standing position or in dorsal, lateral or ventral recumbency, depending on the
type of operation and whether or not the animal is quiet. Horses and nervous
cattle should be knocked by ropes or a short-acting knock-down anaesthetic.
Nervous animals may be given a tranquilliser i/v.
Recumbent animals should be roped securely and an attendant should ensure
that the head is kept down. A blindfold over the animal's eyes helps to avoid
fright by visual stimuli. Unnecessary noise, movement and fuss should be kept
to a minimum.
The standing position may be used for surgery in quiet cattle. An attendant may
hold the nose and the animal should be restrained in a suitable cattle crate, or
ropes may be used through rings in the wall to keep the animal in one position.
Kicking may be prevented by the usual methods as applied in operations under
local anaesthesia.
Small animals are normally operated on in lateral, dorsal or ventral
recumbency. If a special operation-harness is not available they are restrained
by tying bandages from the hocks and elbows to suitable anchor-points on the
operating table. Dogs are excellent subjects for AA but it is advisable to tie a
tape bandage around the jaws to prevent biting. It helps if the owner or an
attendant talks to the dog and comforts the animal from time to time during
surgery. Cats are difficult animals to handle and some vets who have tried AA
in cats have ceased to use the technique in this species.
 AA TECHNIQUES IN LARGE AND SMALL ANIMALS

Electro-AP analgesia (EAA) is the most common method used. When the
animal is properly restrained, AP needles are placed to the correct depth in the
AA points related to the operation site.
The stimulator is checked to ensure that the power switch is off. The output
leads are then connected to the needles. Do not connect the leads from one
output across the thoracic or posterior cervical region. This is especially
advisable if the instrument uses (+) and (-) electrodes. In this case the correct
connection would be as in the diagram on the next page.
An output circuit placed across the thorax may interfere with cardiac function
and may, on rare occasions, cause cardiac arrest. Tape or suture the needles
firmly in position. Otherwise, they are liable to become dislodged by muscle
twitches induced by the stimulation, or by struggling in nervous animals.
When the needles are in position, the output controls are checked to ensure they
are set at zero. Attach the leads and turn on the power switch.
Turn up the output controls slowly until the needles begin to twitch in time
with the frequency of the stimulator. Increase the output voltage from each
control to the maximum tolerance of the patient. At that point, the animal
indicates a degree of discomfort or pain (restlessness, defensive reaction,
struggling, vocalisation etc). Reduce the output to a "strong but acceptable
level" (that which can be tolerated without obvious discomfort). Excessive
stimulation reduces the EAA effect and to weak a stimulus may induce little or
no analgesia. Note: A needle can not twitch unless it is embedded in reactive
muscle. As long as one of a pair is twitching, the paired needle is also receiving
a similar stimulus. Needles may not twitch in points such as GV26.
If output voltage is too high at such points, the animal will indicate discomfort.
In that case, reduce the output to the tolerance of the patient. Every 5 minutes
or so, after switch-on, the operation site is tested for analgesia using rat-tooth
forceps, towel clip, clamp or pin prick. Initially, full sensitivity to pain is
present, as indicated by local muscle twitch or guarding, vocalisation or
defence reactions/struggling.
After 5-10 minutes, the response to pain stimulus decreases. After 20-40
minutes, in successful cases, the animal makes no response to strong pain
stimuli in and around the operation site. The operation may then commence.
Pain stimuli may exceed the hypoalgesia (thereby inducing pain response by
the animal) at certain stages of the operation, especially during incision and
suturing of the skin, serosa (peritoneum, pleura etc) and incision of periosteum
and nerves. During these stages of the operation the frequency or output
voltage should be increased. This is normally sufficient to counteract the pain.
Occasionally (in those animals which respond poorly to AA) it may be
necessary to use small volumes of local anaesthetic injection or spray at these
stages. In the first few minutes after stimulation begins it is usual for the animal
to show a mild stress reaction (dilated pupils, increased blood pressure, faster
 respiration and heart rate). These quickly return to normal or near normal
levels, and should remain at this level during the operation.
Studies of EEG patterns in animals under AA indicate that brain waves are in
the alpha range (8-13 cycle per second) i.e., similar to those of drowsiness or
light sleep. However, the animals are still conscious and can eat or drink and
(in dogs) wag the tail if petted by someone they know. Because sight and
hearing are unaffected (pupil reflex is also intact), unnecessary noise should be
avoided and a blindfold may be desirable.
Pupillary dilation and salivation occurs in some animals. If salivation is
excessive or retching/vomiting occurs, this usually indicates that excessive
traction on mesentery/internal organs is the cause. This may be partly
counteracted by increase in frequency or output of the AA stimuli.

ELECTRO NARCOSIS

Since the end of the last century many investigations with electroanaesthesia
have been performed in animals and man. The interest in this method of
anaesthesia has emerged because anaesthesia is achieved immediately after the
onset of the current and the recovery is very rapid after cutting off of the
current. Recently a battery operated appuratus became available (Feenix
Stockstill) for application of electroanaesthesia and electroimmobilisation
under field conditions, and an experiment was conducted with 10 calves, 10
sheep, and 9 pigs, which were equipped with EEG and ECG electrodes. to
check the analgesic and other practical effects of the apparatus. The duration of
current administration was 20 minutes. Three animals of each species were
used as control animals.
In all animals, during administration of the current, the breathing movements
appeared to be somewhat impaired. The body temperature, the plasma cortisol
level, and the pulse rate were raised durring the current administration.
Moreover, the pulse rate was irregular.
The corneal reflex remained positive in all animals, and the reaction to painful
stimuli was positive in 15 out of 29 experimental animals. The body
temperature, pulse rate, and plasma cortisol level remained constant in the
control animals. Before and after administration of the current the
electroencephalogram recordings were similar, except in one calf and one
sheep, both of which showed patterns suggesting a decreased consciousness.
The electrocardiogram recordings showed pronounced changes in cardiac
activity. In one pig the heart activity stopped some minutes after the onset of
the current. Changes in the electroencephalogram and electrocardiogram were
not observed in the control animals during their treatment.
The results suggest that the apparatus did not cause electroanaesthesia or
electrosleep but had mainly an electroimmobilising effect on the experimental
animals. Because of the dubious effects on the animals' welfare, the use of such
an apparatus cannot be recommended.

HYPOTHERMIA
 Hypothermia may develop in animals anesthetized in a cool environment. A
decrease in temperature of 1-3C below normal has been demonstrated to
provide substantial protection against cerebral ischemia and hypoxaemia in
anaesthetized dogs. Life threatening cardiovascular depression may develop
when the temperature decreases below 32.8C.
Rectal or esophageal temperature should be monitored at regular intervals
during inhalation anesthesia , during protracted total intravenous anesthesia and
during recovery from anesthesia. Basically ,the causes consists of a reduction
in heat production by the animal , usually coupled with an increased heat loss.
It is very difficult to influence production of heat but care should be taken not
to wet the animal excessively to reduce evaporative heat losses, placing the
animal on a warm surface and covering with blankets , drapes , wrapping of
extremities with towel and blanket and plastic insulation or hot air circulating
devices.
Respiratory heat losses are increased when animal breathes cold dry gas from
non-rebreathing system, such losses are reduced by the use of rebreathing
circuits,and also maintaining low flow rate and attachment of humidifier to
endotracheal tube. Fluids to be administered i.v. should be warm.

The adverse effects of perianaesthetic hypothermia are

1. Impaired cardiovascular function.

2. Hypoventilation
3. Decreased metabolism and detoxification of anesthetic drugs
4. Weakness during recovery
5. Decreased resistance to infection
6. Increased incidence of surgical wound infection
7. Increased postoperative protein catabolism

MODULE-17: MUSCLE RELAXANTS

Learning objectives

This module deals with

Physiology of neuromuscular transmission

Reversal of Neuromuscular Blockade
Ventilation

INTRODUCTION
 Anaesthesia is comprised of narcosis, analgesia and muscle relaxation.
Muscle relaxation is best achieved by the administration of neuromuscular
blocking agents.
Use of neuromuscular blocking agents
To provide the muscle relaxant component of anaesthesia
To minimize the dose of general anaesthetics
To provide easy access to the deep structures in the abdomen
To aid in intubation without laryngeal spasm
To prevent fighting the ventilator during controlled ventilation
To help removal of foreign bodies from the proximal portion of oesophagus as
it is composed of striated muscles.
To aid in reducing the luxated joints
To ensure immobility of the patient during delicate surgery
To stabilize the eyeball in central position during ophthalmic surgery

PHYSIOLOGY OF NEUROMUSCULAR TRANSMISSION

The large myelinated nerve from the ventral horn of the spinal cord carries
impulses to the muscles. It carries stimuli to several muscle fibres that must be
activated for contraction.
As the nerve approaches the muscle cell its branches lose their myelin sheaths
and the terminal ends lie in grooves on the surface of the muscle fibre and are
covered by Schwann cell. The area where the nerve ending lies close to the
proximity of the muscle fibre is called neuromuscular junction.
The muscle fibre membrane forms the groove and the grooves are deeply
corrugatede and called as secondary clefts. The small gap between the nerve
fibre terminal and the muscle membrane is 60 nm wide and is called as
junctional cleft. The areas of secondary cleft are rich in mitochondira.
The action potential traveling along the motor fibre produces depolarization of
the nerve terminal and triggers the release of acetylcholine, which crosses the
junctional cleft to stimulate nicotinic-cholinoceptors of the post synaptic
muscle membrane.
Acetylcholine is synthesized from choline and acetate in the presence of an
enzyme acetyltransferase. The acetylcholine molecules are present as uniform
sized vesicles near the presynaptic membrane and these areas are called as
active zones.
When acetylcholine is released it travels a minimum distance across the
junctional cleft to reach the receptors. Interaction between the receptor and
acetylcholine triggers an end plate potential, which is converted into muscle
action potential leading tocontraction. After activating the receptor the
 acetylcholine is rapidly hydrolysed to choline and acetate. The drugs used for
neuromuscular blockade are classified into
o depolarizing muscle relaxants
o nondepolarizing muscle relaxants.

DEPOLARIZING MUSCLE RELAXANTS

Depolarizing drugs produce intial muscle fasciculations and their action is

rapid. Depolarized muscles are unresponsive to other stimuli such as electrical
stimulation. Their action is not reversed by anticholinesterases. In partial
paralysis neuromuscular monitoring slow depression of muscle twitch, no fade
and no post titanic facilitation are noticed. The only drug used in this group is
suxamethonium chloride (Succinyl choline). It is hydrolysed by cholinesterase
and pseudocholineesterase into choline and succinic acid. Cholinesterase is
synthesized in the liver. Hence liver damage, cachexia and malnutrition may
prolong the action of suxamethonium. Organophosphorous compounds (use as
ectoparasiti-cides) decrease the action of pseudocholinesterase, hence not
recommended in patients recently exposed to such agents.
Isoflurane, respiratory alkalosis, hypothermia and magnesium ions potentiate
the effect of suxamethonium. Its effects are antagonized by halothane, acidosis
and nondepolarizing drugs.
Its administration is associated with the release of potassium into the blood
from the muscles, which may result in cardiac irregularities. However
prolonged administration results in decrease in serum potassium level.
In dogs 0.3 mg/kg intravenously produces muscle relaxation and it extends
upto 25 to 30 minutes. Repeat dose may result in dual block (nondepolarizing)
which can be reversed with anticholinesterase drugs.

NONDEPOALRIZING MUSCLE RELAXANTS

These drugs do not produce muscle fasciculations and are slow in action. Their
effects can be reversed using anticholinesterase.
The relaxed muscles will response to other stimuli such as electrical stimuli.
During partial paralysis monitoring it shows fade andpost titanic facilitation
followed by exhaustion and depression of muscle twitch.
Acidosis, magnesium slats and volatile anaesthetics potentiate the action of
these agents.
Nondepolarizing drugs are either quaternary ammonium or steroid compounds.
The following are nondepolarising muscle relaxing agents
o Tubocurarine chloride
o Gallamine triethiodide
o Pancuronium bromide
o Vecuronium bromide
o Atracurium besylate
 TUBOCURARINE CHLORIDE

Tubocurarine is derived from Chondrodendron tomentosum tree. Not

recommended in dogs due to its profound cardiac defects/effects.

GALLAMINE TRIETHIODIDE

It has atropine like action on the heart.

It also blocks the muscarinic effects of acetylcholine and acts directly on the B
receptors resulting in tachycardia and rise in blood pressure which may lead to
greater blood loss during surgery.
This drug is excreted through kidney hence not indicated in patients with renal
diseases.
Dose - 1 mg/kg I.V, Duration: around 29 minutes.

PANCURONIUM BROMIDE

It is an amino-steroid having no steroidal effects.

Only 30% is metabolises and the rest is excreted unchanged through bile (10%)
and the reaming through the kidney.
It is contraindicated in patients having renal and hepatic diseases.
It has minimal effects on cardiovascular system and some times produces rise
in heart rate.
Dose 0.06 mg/kg I.V, Duration around 31 minutes.

VECURONIUM BROMIDE

It is a steroidal agent supplied in lyophilized form and soluble in water (stable

for 24 hour only).
Its duration of action is less than pancuronium.
The drug is primarily excreted through bile in an unchanged form hence can
not be used in patients with hepatic diseases and recommended in patients with
renal disorders.
It has got minimal cardiovascular effects and does not release histamine.
Dose 0.1 mg/kg I.V., Duration 18 to 25 minutes.

ATRACURIUM BESYLATE

It is a novel muscle relaxant, which does not depend on body system

tometabolize.
It is broken down by a self-destruction process known as Hofmann elimination.
It is a safer drug for cardiac and renal patients.
It is administered with caution inpatients with the history of anaphylaxis as it
may release histamine.
 Dose: 0.5 mg/kg I.V, duration around 40 minutes further maintenance can be
done with incrementaldose (0.2 mg/kg) or by continuous infusion (0.5
mg/kg/hr).

CISATRACURIUM BESYLATE

This drug is 5 times potent than atracurium, has no cardiovascular effects, does
not release histamine, and is eliminated by Hofmann effects.
No clinical literature is available on its use in veterinary anaesthesia.
The other nondepolarizing drugs are mivacurium, rocuronium and doxacurium.

REVERSAL OF NEUROMUSCULAR BLOCKADE

Reversal of nondepolarizing drugs is achieved by establishing high

concentration of acetylcholine at the binding site.
It is achieved by the administration of certain drugs, which will inhibit
cholinesterase, and the drugs are pyridostigmine, edrophonium and
neostigmine.
In clinical condition reversal is attempted when at least two twitches are
present.
Atropine (0.04 mg/kg) or glycopyrrolate (0.01 mg/kg) administered
intravenously atleast one minute prior to the administration of reversal agent to
block the muscarinic effects of acetylcholine.
Neostigmine 0.1 mg/kg I.V or Edrophoniumj 1.0 mg/kg I.V.
Intermittent positive pressure is discontinued only after achieving train of four
responses (all must be of equal force).
The action of neuromuscular blocking agents are potentiated and prolonged by
aminoglycoside antibiotics e.g. streptomycin, gentamicin, and tobramycin by
decreasing the release of acetylcholine. Calcium can be given prophylactically
in these patients. The other antibiotics include polypeptide antibiotics like
tetracycline, lincomycin and metronidazole.

VENTILATION

There following are the different types of ventilation

o Spontaneous ventilation
o Assisted ventilation
o Controlled ventilation
o Intermittent positive pressure ventilation
 TYPES OF VENTILATION

Spontaneous ventilation

It refers to breathing without any assistance from mechanical ventilator or the

anaesthetist squeezing the rebreathing bag.
Spontaneous ventilation can be abolished by hyperventilation.

Assisted ventilation

The patient initiates the respiration but the tidal volume is increased or
assistedby the ventilator or by squeezing the rebreathing bag.

Controlled ventilation

The total breathing function of the patient is done entirely by a mechanical

ventilator or by the squeezing of rebreathing bag.

Intermittent positive pressure ventilation

This is a technique used in controlled ventilation or assisted ventilation to force

air into the lung during inspiration and lower it to atmospheric pressure or
slightly below during expiration.

USES

To provide ventilation during neuromuscular blockade and respiratory muscle

paralysis due to toxins.
To maintain near normal acid base status and oxygenation during long surgical
procedures.
To reduce ventilation-perfusion mismatch during prolonged periods of
anaesthesia.
To provide controlled respiration during thoracotomy. Intermittent positive
pressure ventilation is essential to maintain pulmonary function in dogs, cats
and in horses during open thorax as their mediastinum is incomplete.
(fenestrated mediastinum). In cattle, sheep and goats the mediastinumis
complete (unfenestrated mediastinum) hence thoracotomy can be performed in
one side with out the need of ventilator. But still use of intermittent positive
pressure in these animals also helps in maintaining cardiopulmonary
parameters.
Used in patients whose respiratory centre is depressed by drugs, increased
intracranial pressure, cerebral ischemia, and cardiac or respiratory arrest.
 Used in thoracic diseases, which affect the negative pressure of the thorax. (-5
cm of H2O during expiration and -12 cm of H2O during inspiration) eg.
Diaphragmatic hernia, pleural effusion, pneumothorax.
Used in patients having inadequate respiratory exchange due to obstruction or
pulmonary oedema.
Guidelines
o Volume, pressure, rate and inspiratory: expiratory ratio must be properly
set in the ventilators.
Volume
o Small animals 10 to 20 ml/kg
o Large animals 10 to 15 ml/kg (maximum limit is for open thorax)
Pressure
o 15 to 30 cm of H20
Rate per minute
o Dogs 8--- 14
o Cats 10---14
o Horses 6 --- 10
o Cow 6 --- 10
o Sheep & goats 8 --- 12
o Pigs 8 --- 12
Inspiratory: Expiratory ratio
o It should be 1:2 or 1:3 to minimize the interference with venous return
the inspiratory time is kept shorter than expiratory time.

MODULE-18: GENERAL PRINCIPLES OF CHEMICAL RESTRAINT OF

WILD AND ZOO ANIMALS

Learning objectives

This module deals with

Chemical Immobilization of Wild Animals

CHEMICAL IMMOBILIZATION OF WILD ANIMALS

Wild animals are chemically restrained for the following reasons

o Animal translocation and transportation
o To study the ecology and population estimate
o For veterinary studies
o To relieve wild animals in distress
 o Control of animals causing distress to the public
Various devices used for injecting the drug from a distance are drug darts,
projectile syringes (short range, long range, and extra long range), blow gun
rifle, blow pipe, and stick syringe.

Primates

Ketamine 5-20 mg /kg intramuscular

Xylazine 2 mg/kg intramuscular

Chimpanzee

Ketamine 10-15 mg/kg body weight

Xylazine 2 mg/kg

Kangaroo

Xylazine 8 mg/kg body weight and Ketamine 3 mg/kg combination

Thiopentone less than 20 mg/kg body weight

Antelope

Xylazine 0.23 mg /kg and Ketamine 11.54 mg/kg body weight combination

Deer

Xylazine 0.89-8.0 mg/kg body weight

Ketamine 10-20 mg/kg body weight

Camels

Xylazine 0.27-0.51 mg/kg intramuscular

Bears

Xylazine 2-4 mg/kg and Ketamine 4.5-9mg/kg (Combination)

Bison

Chloral hydrate 250mg/kg body weight

Elephant

Asian elephant 100-175 mg Xylazine (total dose)

 Etorphine-Acepromazine combination (2.4 mg/ml-Etorphine and 10mg/ml of
Acepromazine per ml) Dose 1 ml/4 feet of shoulder height

Reptiles

Ketamine 20 mg/kg intramuscular

Xylazine 1 mg/kg

Snakes

Ketamine 50-130 mg/kg intramuscular

Tiletamine 10-20 mg/kg intramuscular

MODULE-19: ANAESTHESIA OF LABORATORY ANIMALS

Learning objectives

This module deals with

Injectable Anesthesia
Inhalant Anesthesia
Gas Delivery Systems
Anesthetic Machine
Preparation, Monitoring and Maintenance of normal physiology

INJECTABLE ANESTHESIA
 Anesthetic induction using injectable anesthetics is fairly simple. It
involves admininsistration of the drug and monitoring the depth of
anesthesia. Supportive care may be needed. Maintenance of injectable
anesthesia can be through repeated bolus doses of the drug or through a
constant infusion. Infusion rates are calculated based on the clearance
time of the drug. Bolus dosing is simpler. Typically, 1/2 of the original
dose is given for repeat doses.
Injectable anesthetics can be administered by various routes depending
upon the specific compound. The most frequently used routes of
administration in laboratory animals are intraperitoneal, intramuscular
and intravenous. Less frequently used routes, among others, are
intrathoracic, oral and rectal. Techniques are described below. Contact
RAR at 624-9100 for training materials on handling animals and
administering injections.

Intravenous(IV)

Method - An appropriate vein must be selected. For large animals, the

saphenous, cephalic or jugular veins are best. For rodents, the tail veins
are best. For rabbits and swine, ear veins may be used. The vein is held
off proximal to the venipuncture site. The vessel may be stroked with a
finger to stimulate blood flow into it. The needle is inserted at a 30-45
angle to the vessel. Then the needle is lowered to align with the
longitudinal axis of the vessel and advanced slightly. Draw back. If blood
appears in the hub of the needle, the drug may be injected. If not, try
redirecting the needle (before you pull it out of the skin) and repeat. You
may need to try several times while learning. Using a new, sharp needle
for each stick, even if it is the same animal, will improve your chances
for success. Once the needle is withdrawn, it is necessary to put pressure
on the vessel to prevent bleeding.
Advantages - rapid delivery of drug, ability to titrate dose, irritating
substances may be given IV
Disadvantages - small veins are hard to access (i.e. small animals),
restraint is critical, developing skill in venipuncture takes experience

Intramuscular(IM)

Method - Insert the needle into a large muscle mass. Draw back slightly.
If blood is aspirated, you are in a blood vessel. Redirect the needle.
When the needle is placed correctly, inject the drug. The best muscle
masses to use are for small animals, the caudal thigh muscles. For larger
animals, the lateral dorsal spinal muscles or the cranial or caudal thigh
muscles may be used. When administering into thigh muscles, inject
from the lateral aspect, or if from the caudal aspect, direct the needle
slightly lateral. This will help avoid injecting into the sciatic nerve.
Advantages - Fairly rapid absorption, technique is simple
 Disadvantages - IM injections are painful, small volumes are necessary,
the animal may try to bite or escape

Intraperitoneal (IP)

Method - The animal is usually restrained in dorsal recumbency. The

drug may be injected anywhere in the caudal 2/3 of the abdomen.
However, it is best to try to avoid the left side in rodents and rabbits
because of the presence of the cecum. After the needle is inserted, draw
back. If anything is aspirated, you have likely hit the viscera. Withdraw
and get a new needle before trying again. If the needle is placed
correctly the drug may be injected.
Advantages - relatively large volumes may be injected (0.5 ml in mice, 2
ml in rats, etc.)
Disadvantages - technique is more difficult than IM injections, drug
may be administered into the viscera resulting in no effect or in a
complication.

Subcutaneous (SQ)

Method - Pinch an area of loose skin. Inject into the center of the "tent"
created by pinching.
Advantages - Technique is the simplest of any, large volumes may be
given (basically as much as the tent of skin will hold that doesn't cause
discomfort to the animal)
Disadvantages - Irritating substances cannot be given this way,
absorption is slow

INHALANT ANESTHESIA

Induction of inhalation anesthesia can be difficult. Anesthetic gases are

irritating to eyes and nasal passages. Animals may resist as they begin to
lose consciousness or they may stop breathing temporarily. For this
reason induction using a mask or nose cone held over the animal's nose
can only be performed on smaller or non-fractious animals. In smaller
animals gas can be delivered into an induction chamber large enough to
contain the entire animal. Induction via a nose cone or chamber
requires delivery of the anesthetic gas at 2-3x MAC. Frequently an
injectable anesthetic is used to induce anesthesia and the inhalation
agent is used for maintenance.
Maintenance of inhalation anesthesia is normally accomplished by
delivering approximately 1.2 MAC to an animal via a mask or nose cone,
 or directly into the lungs via an endotracheal tube. Intubation is
recommended whevever possible, particularly when a procedure will be
prolonged. Endotracheal access is essential to provide ventilation
support.

GAS DELIVERY SYSTEMS

The most complicated aspect of using inhalant anesthesia is the delivery

system. A delivery system must provide the anesthetic gas to the animal
at a known and constant rate.
It must also ensure that animals receive adequate oxygen. There are
several types of delivery systems typically used in laboratory animals.

ANESTHETIC MACHINE

The best method of delivering an inhalant anesthetic is with an

anesthetic machine. These machines precisely mix the gas with air or
oxygen and can be easily adjusted. Machines can vary in construction
and design. Anesthetic machines typically require more training to learn
to operate.
Anesthetic concentration is accomplished by sets of mixing valves or a
precision vaporizer. Vaporizers are easier to use but are very expensive.
Vaporizers are calibrated for the specific anesthetic gas to be used.
Anesthesia circuits can be re-breathing or non-rebreathing.
o Re-breathing circuits include typical circle systems used in large
animals. The gas/oxygen mixture is delivered to the animal via a
one-way valve. When the animal breathes out the gas passes out
another valve attached to a y-piece. This is passed over a carbon
dioxide absorbent and then back into the system. Additional gas
and oxygen are continuously delivered to replace that lost.
o Re-breathing circuits conserve anesthetic gas and the animal's
body heat. The CO2 absorbent must be replaced regularly.
o Non-rebreathing circuits are primarily used for smaller animals
that cannot cycle the valves in a re-breathing system. With newer
machines non-rebreathing circuits are normally only necessary
for rodents and birds. In older machines with metal valves a non-
rebreathing circuit may be necessary for rabbits and cats as well.
A Bain system is the most common non-rebreathing circuit
available.
 o The non-rebreathing circuit is attached to the same anesthetic
supply as used for a re-breathing system. However, the exhaust
line is connected directly to the waste gas scavenging system.
o Non-rebreathing circuits depend on gas and oxygen being
delivered at a higher pressure than is present in the exhaust line.
This tends to increase anesthetic usage and can increase body
heat loss in the patient.
Anesthesia machines must have a waste gas scavenging system.
Normally the exhaust line on a non-rebreating system or the pop-off
valve on a re-breathing system is connected to a vacuum line or to the
building exhaust. Other scavenging systems can be used, contact RAR at
624-9100 or Environmental Health & Safety at 626-5804 for further
information on anesthetic delivery systems.

Apparatus for rodent anesthesia

Left: a non-re-breathing nose cone that can be used with a large animal
anesthetic machine; Middle: a typical drop system closed anesthetic
chamber; Right: a gas scavenging system that can be used with a drop
system.

PREPARATION, MONITORING AND MAINTENANCE OF

NORMAL PHYSIOLOGY

A variety of things must be done to prepare for anesthesia. Once

animals are under anesthesia they must be monitored closely while they
are anesthetized to ensure that they do not become too deep and die,
and to ensure that they do not become too light and experience pain
from the surgical procedure.
Normal physiologic functions such as body
temperature, respiration and cardiovascular function must also be
monitored and supported while the animal is anesthetized.
For all major surgical procedures on non-rodent mammals, an intra-
operative anesthesia record must be kept and included with the
 surgeon's reports as part of the animal's record. The anesthetist must be
prepared to handle emergencies if they occur.

PREPARATION

Withhold food and water from large animals for 12 h prior to

anesthesia and from small animals for 2 h to prevent regurgitation and
aspiration. It is not necessary to withhold food and water from rodents
prior to anesthesia. Prolonged food or water deprivation are distressful
to animals and are rarely necessary. Please consult RAR's policy for
fasting requests.
Have all drugs and equipment ready before the animal is
anesthetized. You may not have time to look for things once the animal
is under.
Have an assistant: Anesthesia takes time to perform and monitor. A
person should be available to assist so the surgeon does not have to
break sterility to monitor the animal or administer medications.
Premedication with atropine or glycopyrrolate (anticholinergics) may
reduce the respiratory tract secretions in some animals
Protect the eyes from drying out using an ophthalmic ointment and
protect them from being contaminated with surgical scrub solutions.
Also protect pressure points, such as bony protrusions, from pressure
necrosis or peripheral nerve damage by providing padding between the
animal and the table.

RESPIRATION

Most anesthetics cause direct depression of the respiratory center in the

brain and reduce ventilation. This is complicated by other factors that
may interfere with respiration. When an animal is in lateral recumbency
the lung that is down is being compressed by the rest of the body.
Likewise, animals in dorsal recumbency may experience compression of
the diaphragm by abdominal viscera.
The airway may be compromised by regurgitated food or pharyngeal
and tracheal secretions that normally would be removed by reflex
swallowing or coughing. These reflexes are lost during anesthesia. There
are several ways to monitor and support the ventilation of an
anesthetized animal.
Intubate the trachea whenever possible, even if injectable anesthetics
are being used. Intubation can be achieved on animals as small as a rat.
This will prevent aspiration pneumonia and allow you to assist
respiration if the animal stops breathing. Contact RAR at 624-9100 for
training materials.
Assist respiration during the procedure. This can be done with a
mechanical ventilator. However, mechanical ventilation is rarely needed
 (unless a thoracotomy or diaphragmectomy is being performed) and can
be detrimental to the animal if over-done. Attaching an AMBU bag to
the endotracheal tube or using an anesthetic machine's rebreathing bag
will allow you to administer a deep breath every 2-5 min during the
procedure. This will inflate all areas of the lungs and improve gas
exchange. If the animal is not intubated, ventilation can be performed
using a nose cone or face mask.
Monitor respiratory function throughout the procedure and recovery.
o Monitor respiratory rate and depth (compare to normal for your
species. You can expect them to be slightly decreased). Observe
chest movement, or use a stethoscope or esophageal stethoscope.
o Monitor the color of the mucous membranes (gums, conjunctiva,
vulvar mucosa). A bluish color means the animal is not getting
enough oxygen- ventilate!
o Red-tinged foam present in the airway along with dyspnea
(difficulty breathing) may indicate pulmonary edema. This can
result from overventilation or overhydration. A diuretic
like furosemide can be administered, but prognosis is poor.
o Sophisticated respiratory monitoring can be achieved by
measuring blood gasses, or expired oxygen and carbon dioxide
concentration or by use of a pulse oximeter.

FLUID THERAPY

Many anesthetics have direct effects on the heart or vasculature,

decreasing cardiac output and blood pressure. This is further
complicated by increased fluid requirements during anesthesia and
surgery that may result in hypovolemia.
Fluid requirements are increased because: breathing dry, cold oxygen (if
inhalant anesthesia is used) increases respiratory fluid loss; the animal
has not received its normal fluid intake since it was fasted; fluid may be
lost through hemorrhage or exposure of moist viscera to room air; many
anesthetics are metabolized in the kidney (creating a slight diuresis
minimizes renal toxicity).
To minimize the effects of surgery and anesthesia on hydration:
o Place an intravenous catheter whenever possible to provide
access for fluids and medications
o Supplement fluids, intravenously if possible; otherwise
intraperitoneally or subcutaneously
Fluid should be supplemented at the rate of 5-10
ml/kg/hour during anesthesia
Monitor hydration status- Overhydration results in
frequent urination and pulmonary
edema, underhydration results in sticky mucous
 membranes, loss of skin elasticity, the eyes sinking into the
orbit, decrease in blood pressure and increase in heart rate
To replace blood loss with saline or lactated ringers,
administer 3X the volume of blood lost by slow IV drip.
Monitor the hematocrit. If it drops below 20%, whole blood
replacement may be necessary.
Monitor cardiovascular function by monitoring one or more of the
following:
o Mucous membrane color and capillary refill time (the time it
takes for the mucous membranes to regain their normal color
after pressure is applied)
o Heart rate and rhythm - stethescope or esophageal stethoscope
o Pulse rate and pressure - using your fingers
o Blood pressure - arterial catheter or Doppler cuff required
o ECG - If the animal has pale mucous membranes, the capillary
refill time is greater than 2 seconds, or if the other cardiovascular
parameters are out of normal range (determine normal for the
species you are using!) you may have a cardiovascular emergency.
Increasing the rate of intravenous fluid administration will
improve cardiac output temporarily. However the depth of
anesthesia will need to be reduced and if there is a primary
cardiac problem it will require specific treatment. Consult with an
RAR veterinarian for more information on anesthetic
emergencies.

THERMOREGULATION

Animals frequently become hypothermic during anesthesia because of

inhalation of cold gases, exposure of body cavities to the room air, and
loss of normal thermoregulatory mechanisms and behaviors.
Hypothermia depresses all physiologic functions, including respiration
and cardiac function, slows the metabolism of anesthetics and results in
prolonged recoveries.
All of these can contribute to anesthetic death. Hyperthermia is less
common, but may occur because of excessive application of heat, hot
surgery lights or malignant hyperthermia in genetically pre-disposed
animals. To thermoregulate your patient:
 o Monitor the body temperature frequently using a
thermometer during the procedure and during anesthetic
recovery. While animal normals vary from species- to-species, in
general, when body temperature drops below 99 F, an animal is
considered hypothermic. Below 95-96 F an animal cannot regain
normal body temperature without supplementation.
o Prevent heat loss by insulating cold surfaces with a blanket
o Prevent heat loss during gas anesthesia by utilizing low flow
techniques that conserve heat
o Supplement heat with a thermal blanket (keep blanket
temperature below 40 C to prevent burns!) or with pre-warmed
fluids
o Treat hyperthermia by administering intravenous fluids or
applying water to foot pads or exposed skin. Only use an ice bath
as a last resort, as it may cause cardiovascular shock.

MONITORING ANESTHESIA

Monitoring anesthesia

The depth of anesthesia must be monitored carefully. Animals that are

too light will experience pain and may move during the procedure.
Animals that are too deep run the risk of experiencing cardiopulmonary
arrest. If an animal is too light the anesthesia should be supplemented,
if too deep, animals on gas anesthesia can be turned down.
Animals given injectable anesthetics can not be lightened directly.
Instead respiratory and cardiovascular support must be administered
until the anesthetic is metabolized and the animal begins to lighten on
its own.
To monitor the depth of anesthesia, perform the following:
 o Reflexes - these reflexes disappear as the animal becomes
deeper in the following order:
Palpebral reflex - touching the eyelids causes blinking. The
animal is light if it is blinking.
Toe pinch reflex - pinching the toe or foot web will cause a
pain response. If the animal withdraws the toe it is not deep
enough. If it doesn't, it is not sensing pain.
Corneal reflex- touching the cornea of the eye with a tuft of
cotton results in a blink. Once the animal has lost its
corneal reflex, it is too deep.
o Muscle tone increases as the depth of anesthesia decreases,
unless the animal is receiving a cataleptic drug like ketamine in
the absence of a sedative. Test muscle tone by pulling on the lower
jaw or a limb. Rigid tone indicates inadequate depth of
anesthesia.

Monitor cardiopulmonary function and body temperature

As an animal becomes too deeply anesthetized, respiration and cardiac

output decrease, resulting in poor blood oxygenation and tissue
perfusion and decreased blood pressure and temperature. Likewise,
elevations in heart rate and blood pressure may be indications that an
animal may be feeling pain and is anesthetized too lightly. Monitor as
previously described.

Anesthetic Dose Indications

Emergency (mg/kg)
Drugs
Doxopram 1-5 IV (10x in Respiratory stimulant, for complete
(Dopram) farm animals) respiratory arrest only, use with CPR
Furosemide (Lasix) 2- IV, IM For pulmonary edema. Administer as
needed
Naloxone (Narcan) 0.04 IV For reversal of narcotic sedation or
respiratory depression
Yohimbine 0.1-0.15 IV Reversal of xylazine or detomidine
sedation
Atropine 0.02-0.04 IV For bradycardia
Epinephrine 0.1 ml/kg IV, For cardiac arrest only. Administer IV,
(1:1000) IT, IC, IM intratracheal or intracardiac and
perform cardiac massage
Lidocaine 2, IV (0.5 For diagnosed ventricular tachycardia
mg/kg in cats) only. Administer to effect and monitor

Recovery

Monotoring and support must continue until the animal is completely

recovered from anesthesia. Complete recovery means the animal is able
to hold itself in a normal upright position, has returned to normal body
temperature and all physiological indices are within normal limits.
Anesthetic recovery can be rapid for gas agents and short anesthetic
episodes. Recovery time can be prolonged if animals were under for a
long time or if injectable agents were used.

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PART III

DIAGNOSTIC IMAGING SECTION

MODULE-20:
 PRODUCTION AND PROPERTIES OF X RAYS

Learning objectives

This module deals with

Types of X-ray apparatus

Parts of X-ray machine
Production of X-rays
Properties of X-rays

BASIC INTERACTION OF X-RAY WITH MATTER

For an x-ray examination, the part to be examined is kept between the x-ray
source and an x-ray film. Thus the x-ray beam emitted by the machine traverse
through the part to be examined to reach the film, carrying useful information
that is recorded as a image on the film. While passing through the patient.
Some x-rays are differentially transmitted through the patient carrying
information.Some photons are absorbed and least to exist.
Some are deviated from their course as scatter radiation which decreases the
quality of a radiograph by causing fog on the film.X ray photon can interact
with matter in five ways of which the Photoelectric effect and Compton effect
are important in diagnostic radiology.
o Coherent scattering
o Photoelectric effect
o Compton effect
o Pair production
o Photo disfiguration

Photoelectric effect

The effect is mostly produced when x-ray photos interact with inner shell
electrons of a atom (KLM). It occurs more with low energy incident photons
and high atomic numbers element, provided that the photons have sufficient
energy to over come electron building energy with atom.

Compton effect

As an incident photon encountered a free electron of the outer shall of the

atom, the photon travel in a new direction as scatter radiation.Compton effect
produce almost all the surface radiation encountered is diagnostic radiology.It
is the major radiation hazzard y fluorspar examinations.
Photon defected at a narrow angle is electron to reach the film being exposed to
cause fog.When an incident photon with energy slightly greater than the
binding energy of a k shell electron encounter the scatter, the k shell electron is
 affected from its shell. The photon disappears as most of its energy is utilized
to over come the binding energy of k shell electron.
The free electron flies off as photoelectron. Another electron from an adjacent
or outer shell of another atom immediately fills in to the void created by an
ejected electron. As this electron drops in to the created void, it gives off
energy is the form of characteristicradiation.

Uses in diagnostic radiology

Contrast of the image is enhanced.

No scatter radiation Excellent quality of radiology
Increases radiation ion of patient.

TYPES OF X-RAY APPARATUS

Portable apparatus

Portable x-ray machines are widely used in veterinary practise.

The advantages are
o They are less than other types of machines.
o They need little maintanence.
o They can be operated from any 15 A electrical point .
o They can be easily transported.
o They are light and easily manoeuvered .
The disadvantages is their low milliamperage necessitates longer exposure
time and it predisposes to movement blur. Maximum output is 70 - 90 Kv and
15-30 mA.
Uses
o Suitable for x-raying of limbs below stifle and elbow of large animals
and abdomen and skeletal system of small animals.

Mobile x-ray apparatus

In machines of this type the transformer are larger to permit higher output and
hence cannot be transported easily. They are mounted on wheels , and are
cumbersome to use for restive animals. The output varies from 40-60 mA and
90Kv. (the maximum of 125 kv and 300mA)
Uses
o Can be used for large animal for radiographing head , neck, and limbs
and this machine is quite useful for small animal practices

Fixed x-ray apparatus

This machine requires transformer which have to be built in the room and
special electric connection (3 phase). The output ranges from 300 - 1000mA
 and 120-200kv. This type of mahcines are suitable only for big institutions
because of high expenses involved. Suitable for both large animal and small
animal radiography.

Properties of x-ray beam

X-rays are invisible to eye & travel at high speed & at straight lines
They can penetrate objects depending on atomic no, density, thickness of the
material
Photographic effect - on photographic emulsions x-rays ionises silver halides
on the photo film
Fluoroscent effect - certain chemicals such as zinc sulphide, calcium tungstate
etc fluoresce when exposed to x-rays & emit green or blue light. This effect is
utilised to intensify the x-ray effect by using intensifying screen in the x-ray
cassetes.
Biological effect - x-rays ionises the atoms & bring about disturbances in the
cells by chemical activity which may cause either destruction or activation or
mutation.

Collimation of X-ray beam

The x-rays because of diverting property is capable of extending to a

considerable width. So the X-ray machine incorporate some mean to collimate
or restrict the beam. The purpose is three fold & they are
o To prevent unnecessary radiations of the patients or persons restraining
the animals
o To reduce the scattered radiations.
o To minimize genetrical distortion.
This is done by using cones or light beam diaphragm in a semi-darkened room.

PARTS OF X-RAY MACHINE

It consists of four main parts

o X-ray tube,
o Transformers,
o Tube stand and
o Control panel.

X-ray tube

An X-ray tube consists of a large thermionic diode glass tube which has been
evacuated to produce a high vaccum and in to which are sealed two electrodes,
the cathode (-) and the anode (+).
 Stationary or rotating is placed 1 - 3 cm apart. The glass tube is made of
borosilicate to with stand high temperature generated inside.
The passage of a high kilo voltage electric current across the electrodes results
in the production of X-rays.
The glass tube isfitted in to an oil filled casing and the whole assembly is
housed in a metal encased with lead covering with a small opening for the
useful X-rays to exit after filtration.
The vacuum in the tube creates a free flow for the electron beam and also
prevents oxidation of cathode filament.
This also increases tube life. The oil in the tube helps to dissipate heat apart
from acting as a electrical insulator.
Cathode
o The negative electrode consists of tungsten filament and a focussing cup
and it serves as the source of electrons. Tungsten is preferred because of
its high melting point ( 3370 c) and high atomic number.The tube
current is measured in milliampereage and decides the number of
electrons flowing per second from the filament to the target.
o Modern machines have two filaments made of tungsten -rhenium alloy
to increase the thermionic emission efficiency and hence the tube life.
Focussing cup is a concave cup made of nickel or molybdenum and its
function is to restrict the electron cloud to a small beam.
o Immediately prior to making an x ray exposure the filament is heated to
create an electron cloud by a low voltage current (average about 10 volts
and amperege about 3-5.)The tube current decides the quantity or
intensity of the x rays produced and also can be altered in the control
panel.
Anode
o Anode is the target made up of thin sheet of tungsten embedded in a
copper block serves to obstruct the electrons to make them give up their
energy. As 99 % of it is converted in to heat, the heat produced at the
target is rapidly transferred to the copper block and hence to the oil. The
anode angle differs according to individual tube design and may vary
between 10 deg and 20 deg and the size of the focal spot may vary from
0.3mm to 2 mm.
o It is important that the x ray beam should arise from the smallest
practical portion of the anode. This area is often termed as target or focal
spot.
o Larger x ray tubes possess rotating anode to with stand the heat
generated due to large exposure.
o There are two types of anode - stationary and rotating.
o The stationary one is used in dental x ray machines.

Transformers
 This consists of an auto transformer, a step down or filament transformer and a
high tension transformer.
A auto transformer corrects the fluctuations in input voltage, step down
transformer permits the suitably reduced current to the cathode, and the high
tension transformer produces a high voltage current for the production of x
rays.

Tube stand

This is to support the x ray tube during the exposure.

Control panel

This contains the meters switches, on and off voltameter, kilovoltage selector,
milli amperage selector the timer, and exposure button.

PRODUCTION OF X-RAYS

X rays are produced by energy conversion when a fast moving streams of

electrons is suddenly decelerated in the target anode of the x-ray tube,or by
bombarding a tungsten target with an electron beam it gives up some of
electron of its energy .
Most of the energy (over 99A) will be transformed into heat; the reminder of
the energy will be converted into x-rays.
As x-ray beam passes thriough the patient differential absorption takes place
depending on the tissue density and shadowgraph is obtained.

Electron orbits and energy level

Electrons are negatively charged particles revolving round the nucleus.Since an

atom is electrically neutral in its normal state, it must contain an equal number
of protons and electrons.
The atom resembles a tiny planetary system with the nucleus as the sun and the
electrons as the orbiting planets.
X rays are generated by two different processes when high speed electrons lose
energy in the target of the x ray tube due to radiative interaction.

Characteristic radiation or Line radiation

When the projectile electron interacts with the electron in the K shell of the
traget atom rather than the electron in the outer shell it results in the ejection of
electron in the K shell if the energy of the projectile electron exceeds the
binding energy of the ejected electron. This results in transient electron
vacancy in the K shell into which an electron from the outer shell or from
another atom falls and this process continues till the atom becomes stable. This
 shifting of electrons results in emission of X-ray photon which possoses an
energy equal to the difference between the binding energies of the electrons
involved. Hence the X-ray photon energy is characterisitic of the shells
involved in an element and so called as characteristic radiation.

Bremstrahlung radiation or Breaking radiation

When the projectile electron approaches the nucleus of the atom avoiding the
orbital electrons, it slows down, due to the opposite charges, and gets difflected
from its original course. During this the incident electron loses its kinetic
energy, due to its slow down, and this loss of kinetic energy is emitted as X-ray
photon.
The X-ray produced by this type is called bremstrahlung or breaking radiation.
The incident electron may also collide with the nucleus at times, converting all
its kinetic energy to a single X-ray photon.

TYPES OF X-RAY APPARATUS

X-rays remain the main domain in diagnosis although various other imaging
specialities were later explored and being practiced.
The main reason behind this is the cost of the equipment involved in the latest
imaging techiniques. This makes use of X-rays for its wide application amd so
also its potential harmful effects. Hence physics of X-ray production and
priciples involved must be explained.
Matter in the universe is a substance made up of mass and occupies space.
Einstein law of conversion of energy states matter and energy can neither
created nor destroyed as its mass, energy or charge remain unchanged Like
matter, energy may exist is many forms eg: Kinetic energy, electric energy,
potential energy, chemical energy, nuclear energy, heat energy, electro
magnetic energy etc. energy of one form can easily be converted into another
form. For example X-rays are produced in X-ray machine from electrical
energy.

MODULE-21: FACTORS INFLUENCING PRODUCTION OF X- RAYS

Learning objectives

This module deals with

Factors affecting radiographic quality

FACTORS AFFECTING RADIOGRAPHIC QUALITY

 An good diagnostic radiograph is one is which there excellent details, correct
density and the proper scale of contrast. The proper use of various radiographic
exposure factors KVP, mA Time and FFD are employed.

Detail

Detail is the degree of definitions of an object on a radiograph. Good detail is

the true reproductions of an object. The factors affecting the detail are:
o Shorter Focal Spot film distance. (FFD)
o Closeness of the object to the film.
o Use of intensifying screen.
o Movement of either the patient, cassette on movement of the machine.
o Screens, film contrast.
o Over exposure or under exposure.
o Focal spot size.
o Any condition fogging the film will bring out loss of detail.

Density

Radiographic density is determined by the amount of light absorbed by an

exposed x-ray film and is a measure of the degree of blackness of the film.
Radiographic density is affected by te subject density which the weight per unit
volume of different body constituents.
The density of the radiograph varies directly with milliamperage, provided all
other factors remains constant.
Higher milliamperage produces more x-rays and thus more density and lower
milliamperage results is less density. Radiographic density varies directly with
exposure time.Radiographic contrast is the difference in density between the
image of parts or structures on the radiograph.

Contrast

Contrast is the difference between blacks, grays and whites. There can be long
scale contrast and short scale contrast. Radiographic contrast varies inversely
with the kilovoltage. The lower the kv produces a radiograph with a short
scale of contrast. Secondary radiation and scattered radiations causes lack of
contrast. Improper development of film and use of warm developer cause lack
of contrast.To get good radiograph in veterinary patients the following
technique should be followed
o Fastest exposure time possible (To prevent movement blur)
o Higher kvp.
 o Constant distance
o Constant milliamperage

Viewing of the radiograph

Radiograph should be viewed on a good, evenly lit viewing box, in a semi

darkened room.
Over exposed film should be viewed against bright light. Though provisional
diagnosis can be given on a wet film, it is advisable to wait till the film is dry,
before giving final diagnosis.
When viewing radiographs of the dorsoventral or ventrodorsal or skull, the left
side of the film should be facing the viewers right side and when viewing the
lateral views it would be better that the anterior aspect should be directed
towards the left side of the viewers. Always follow the same conventions.
To give radiological interpretation the viewer must have a comprehensive data
of clinical and physical examinations and also have a knowledge of the range
of radiological animal anatomy and for this a library of normal films taken in
the standard position is an asset.

MODULE-22: PRINCIPLES OF VIEWING AND

INTERPRETING X - RAY FILMS

Learning objectives ------- This module deals with,

Handling of X-rays
Viewing of X-rays
Interpretation of X-rays

HANDLING, VIEWING AND INTERPRETATION OF X-RAYS

Handling

Cassettes with exposed film should be opened in a dark room and the film is
removed by holding the corners. The film is loaded in a suitable size cassette
and stored in lead lined boxes.
 The loaded cassettes and the exposed film cassettes are kept with radiopaque
surface upwards. Unexposed film boxes are always kept in lead lined boxes.

Viewing

Radiography should be viewed on a good evenly lit viewing box in a semi

darkened room.
Dorsoventral chest, ventrodorsal abdomen or skulls are viewed with a right side
of the film facing the viewers left side.
Lateral view radiographs are viewed by placing it facing left. Radiographs of
extremities are viewed with lateral aspect on left side of the viewer.

Interpretation

The three important factors to be considered before interpreting a radiograph

are
o Case history,
o Physical examination and
o Correct radiographic technique.

Radiographic diagnosis

Radiographic diagnosis consists of two parts namely location of the lesion and
classification of the lesion. Location of the lesion requires knowledge of
normal radiographic anatomy, basic radiographic signs in terms of changes
such as size, architecture, contour, density, position and function. A systematic
and methodical examination of each radiograph will prevent overlooking
unexpected lesion.

Classification of Lesion---The lesions in the radiograph are classified as

developmental, metabolic, traumatic, infectious, neoplastic, and degenerative.

Module 23 - RADIOLOGICAL PATHOLOGY OF THORAX

Cardiomegaly

Outline of the heart becomes more rounded.

Occupies a much larger area of the thorax.
Trachea and major blood vessels are seen displaced.
Posterior border of heart becomes straighter.
 Cardiac silhouette in contact with sternum and diaphragm.

Bronchitis

Slight increase in the radio-density of the bronchial tree

Pneumonia

Areas of increased density of lung substance.

Areas of consolidation can be visualized

Pneumothorax

Collapse of the lungs.

Presence of air in the pleural cavity
Floating heart shadow

Fluid in the pleural cavity

Fluid shadow will be masking the structures in the thorax.

Fluid level appears as area of increased density.
Typical leafy appearance

Diaphragmatic Hernia

Disappearance of the normal diaphragm line.

Displacement of lungs and visualization of part of GI tract in thoracic cavity.

Tuberculosis

Areas of opacity in lung parenchyma

Recognition of cavitations and calcified nodules in the lung parenchyma or
pleura.

Module-24 = RADIOLOGICAL PATHOLOGY OF ABDOMEN

Gastric torsion
 Greatly distended gas filled organ occupying the major portion of the anterior
abdomen. Compartmentalization of stomach.

Oesophageal achalasia

Distended organ occupying the upper half of the chest in the lateral view
Dorsoventral view-distended organ projecting beyond the shadow of the spine

Oesophageal foreign body

Thickening of the oesophageal wall

Increased density from that of the surrounding tissues.

Pyloric Obstruction

Enlargement of the stomach

Accumulation of fluids/material (accumulation of barium) in pyloric area.

Intussusceptions

Sausage shaped mass with increased density

Thin layer of gas outlining the layers of intussusceptions
Barium enema- coiled watch spring pattern.

Hydronephrosis

Large mass with a smooth outline in the anterior abdomen filled with fluids,
with appearance of homogenous density

Kidney calculi

Small irregular dense areas roughly central to the kidney outline

Cystic calculi

Radiopaque cystic calculi easily visualized slightly radiopaque calculi can be

demonstrated by using penumo cystography.

Prostate enlargement

Relatively dense mass just anterior and ventral to the pelvic brim in the
position normally occupied by the bladder, which is displaced anteriorly.

Metritis and pyometra

 Slight thickening and enlargement of uterus- may be uniformly tubular or
sacculated.
Displacement of the colon.

Module-25 = RADIOLOGICAL PATHOLGY OF Limb (BONES AND

JOINTS )

Radiographic signs of bone diseases

Altered contour of the bone

Altered size of the bone
Decreased one density
Change in trabecular pattern

Radiographic signs of joint diseases

Widening or narrowing of the joint space

Cystic changes
Swollen joint capsule-soft tissue swelling

Osteoporosis

Diminished density of the bone.

Small animals

Hip dysplasia
o Bony exostosis, new bone formation involving acetabulum- thickened
disorganized appearance of the femoral neck-remodeling and flattening
of the femoral head.
Hip dislocation
o Abnormal width of intra articular space.
Long bone fractures
o Disruption of the continuity of a bone
 Module-26 = CONTRAST RADIOGRAPHY - CLASSIFICATIONS

Radiography is founded upon the principle that an object when exposed to an

incident x-ray beam will absorb a part of the x-ray beam and a part
willpenetrate the object and interact with the film. Radiodense objects absorb
larger percentage of the x-rays than radiolucent objects resulting in less film
exposure and the recording of white object image.
In other words, the absorption of x-ray by the tissues of the body, and thus their
radidensity, depends upon the atomic weight of the principal substances of
which the tissues are composed. That means absorption capacity of an organ or
object is directly proportional to the number of orbital electrons in the atom of
the molecule of the absorbing material (atomic number). Comparison of equal
volumes of different tissues/with their densities.

Density

Barium - 56
Bone - 14 (Average)
Muscle, Organ, fluid
Soft tissue 7.4 (Average)
Fat - 6.3
Gas (Air) - 1 to 2
The differences in density (radiographic contrast) between bones, muscles, fat
and gas form the basis of plain film radiography. Ex: Kidney is seen clearly in
a plain radiography if there is perirenal fat around the organ. Bone is clearer
because of surrounding soft tissues.
But the kidney pelvic is not visible or the mucous pattern of bladder or stomach
are not seen normally due to lack of contrast.
Artificial methods of delineating such organs are required and so a suitable
contrast medium is employed. The contrast medium may have either high
atomic weight and provide positive contrast or a low atomic weight and
provide negative contrast. Examples of positive contrast media re Barium
sulphate, organic iodine compounds. Examples of negative contrast media area
co2, o2 and N20 or atmospheric air.

Positive contrast agents

Positive contrast agents can be precisely classified and may be divided into five
main groups.
Agents used for the demonstration of Alimentary tract.
 The substance used for this purpose should be insoluble and non absorbable
and inert. The substance used routinely for this purpose is barium sulphate.

Water soluble agents

These form the largest single group of contrast agents. The ideal criteria for the
contrast media included in this group are that they should be (1) opaque to x-
rays and they all contain iodine (2) pharmacologically inert (3) very water
soluble so that they can be injected at high concentrations (4) chemically stable
so that the iodine is not released in the body (5) rapidly excreted by the
kidneys; (6) of low viscosity for injecting quickly through a small catheter and
(7) of low toxicity and irritancy so that large quantities can be employed.
The conventional water soluble contrast media are ionic and are therefore
hypertonic and their osmolality ranges from 4 to 7 of that of blood. The newer
low osmolar non-ionic contrast agents have ratio 3 contrast as compared to the
conventional high osmolar ionic contrast agents which have only ratio 16.
Contrast property. Ex: Conray, Urografin (Ionic agent); Iohexol, Iopamidol
metrizamide (non-ionic)
Agents excreated selectively through biliary system to study the gall bladder,
after absorption from alimentary system or intravascular injection. Ex:
Biligrafin and Ipodate calcium powder (solu-Biloptin) (Scheringe).

Viscous and oily agents

These agents are developed to overcome immediate climination which occure

with the water soluble preparation. Viscous solution are used to demonstrate
bronchial tree and the uterus.
Oily solutions are used in those situation in which it is essential to avoid even
the slightest local irritation once introduced they are slowly climinated.

Radiographic quality

Gaseous agents: Are those most frequently employed. They are cheap easy to
administer and are comparatively safer.

INTRAVASCULAR CONTRAST AGENTS AND CONTRAST

RADIOGRAPY
CONVENTIONAL IONIC MEDIA
Generic name Proprietary name
Meglumine iothalamate Conray-280
Sodium iothalamate Conray-420
Meglumine diatrizoate Urografin-150
Sodium diatrizoate Urografin-370
NEW LOW OSMOLAR NON-IONIC MEDIA
Metrizamide Amipaque
Iopamidol Niopam
Iohexol Omnipaque

MODULE- 27 :-CONTRAST RADIOGRAPHY OF THORAX & ABDOMEN =>

THORACIC CAVITY

Angiography

The radiographic demonstration of the vascular system by the injection of a

water soluble organic iodide compound into a suitable vessel. Specialized
techniques
o Arteriography-Arteries
o Venography-Veins
o Aortography-aorta
o Portal venographyPortal vein
o Angiocardiography-Heart and vessels

o Cerebral angiographyCerebral vessels.

o Technique-

Contrast agents are injected rapidly by means of a syringe of an appropriate

volume connected to a hypodermic needle or cannula or catheter which is
inserted into a suitable blood vessel. Radiographs are taken immediately on
completion of the injection.

ALIMENTARY TRACT

Indications

To reveal obstruction of the alimentary tract. Ex: Tumour or stenosis.

To find out distorsion of the wall of alimentary tract such as enlargement. Ex:
Dilatation of stomach or oesophagus.
To find out displacement of the alimentary tract. Ex: Hernia.
To reveallesions in the wall of the alimentary tract. Ex: Neoplasms Ulcer.

Procedure

Oesophaqus
o No preparation is required. Take plain radiography and administer
Barium sulphate paste about 50 to 100 Gms. Orally (Braium Swallow)
and taken with lateral and ventrodorsal projections immediately after
administration.
o Normal oesophequs should not retain bacium. Only a thin streak of
barium indicating the position of the oesophegus and outlining the
 mucous surface is seen as normal oesophagus is a collapsed tubular
structure.
Stomach
o 50 to 100% suspension of about 15 to 100 ml. Is given orally observed
under fluoroscopy or x-rays are taken at regular intervals 10 minutes, 30
mts, 1 hr. and 4 hrs. etc. at different angles like left lateral, right lateral,
ventro dorsal and oblique if necessary to demonstratethe different areas
of stomach and mucosal surface.
o The stomach should be empty by starving overnight or by administering
laxative or enema if necessary.
o Normal stomach start emptying the barium within minutes after the
administration. Space occupying lesions or obstructive lesions can be
easily demonstrated.
Small Intestine
o To promote easy passage of the contrast agent 25% suspension is
preferred. Repeated x-rays at interals could demonstrate lesions inside or
outside the intestine easily. Intestinal motility can be assessed.
Large Intestine
o To demonstrate large intestine barium is best given by enema. Double
contrast gastrography or colonography can be obtained by combining air
(negative contrast agent)
The functional and anatomical abnormalities could be better assessed by means
of flucroscopy apparatus, if available.

MODULE- 28 :- CONTRAST RADIOGRAPHY OF SPINAL CORD &

URINARY SYSTEM =

MYELOGRAPHY

Indication

To outline the neural canal

To demonstrate disc lesions and other space occupying lesions.
Contrast agents used
o Oily fluid containing 40% iodine (Ex. Myodil).
o Water soluble: Metrizamide soluble. Iohexol, Iopamidol solution.

Technique

Cysterna puncture
Lumbar puncture
Under general anaesthesia the contrast agent is injected into the sub-arachnoid
space. In the first method cisterna magna is punctured and in the second
 method sub-arachnoid puncture is made using a spinal needle between 4th and
5th Lumbar vertebral space in lateral recumbent position.If myodil is used the
quantity is 0.5 to 2 ml. Per animal.
The animal may be positioned in an inclined plane for easy flow caudally.
Pictures are taken at 5 mts. And 10 mts. Interval under lateral and ventrodorsal
projection. If Metrizamide or any other water soluble agent is used, 0.3 ml. To
0.5 ml/kg.body wt. Is injected into the subarachnoid space and x-rays are taken
immediately.
The advantage of the new water soluble non-ionic solution is that it gives better
visualization of the spinal canal and the agent gets eliminated within few hours.
In the case of oily agents the contrast material will tend to globulate and remain
in the canal for longer period causing at times undesirable side effects.

UROGRAPHY: (PYELOGRAPHY AND CYSTOGRAPHY)

Intravenous urography (Intravenous pyelography, IVP)

Pyelography is used to demonstrate kidney shadow when it cannot be

demonstrated in a straight radiography.
To show the presence or absence of lesions in the renal pelvis.
To get a rough indications about renal function.
Contrast agents used
o Ionic contrast agents such as sodium Iothalamate (conray-420);
Meglumine Iothelamate (conray-280); Sodium and Meglumine
diatrizoate (Uregrafin 60% or 76%); Sodium diatrizoed (Hypoque).
Non-ionic contrast agents such as Iohexol (Omnipaque-300); Iopamidol
(Niopem) Metrizamide have also been used.
Dosage: To give better demonstration upto 600 mg to 1200 mg/kg. Body
weight may be administered I/V usually 1 to 2 ml/kg. Body weight.
Preparation: With hold food for 24 hrs. and water for 12 hrs. Empty the bowels
with enemata. Anaesthesis as optional
Technique
o Inject the dyeasa single bolus I/V by taking about 1 minute. Straight
firms may be taken before injection and subsequent to injection at 1 mt.
5 mts., 10 mts. And 20 mts. With ventrodorsal and lateral projections.
Use of a compression bandge over the abdomen will enhance the clarity
of renal pelvis and ureter.
o This technique is popularly known as intravenous pyelography or
excretory urography. Another method to carry out this procedure is to
mix the contrast agent about 1200 mg/kg. With 150 to 250 ml. Of
normal saline and given by drip taking about 20 to 40 mt. Time to give
more accurate evidence of kidney function and is a safer method.

Cystography

Indications
 1. To recogrise radiolucent small calculi
2. To demonstrate space occupying lesions in the bladder.
3. To demonstrate abnormal prostate gland.
Preparation: The G.I. tract should be empty. Iodine compund 10 to 20% about
40 to 100 ml. Are employed after catheterizing the bladder.
Procedure: After evacuating the bladder, inject the contrast agent either iodine
solution or air (100 to 300 ml). Radiography is taken (lateral & ventrodorsal
projections). For double contrast small quantity of iodine solution followed by
air may be used for better visualization of the interior of bladder.

Module- 29 =RADIATION HAZARDS AND ADOPTION OF SAFETY

INCREASERS

Dangers of radiations

Ionising radiation used in diagnostic radiography is potentially harmful and if

proper protective measure are taken the risk is small compared with the benefit
to the patient.
Certain tissues especially those which contains many multiplying cells, such as
blood forming organs (bone marrow, lymphoid tissue, spleen), the gonads,
embryos and cetain tumours are radiosensitive.
X-rays have long term effect of producing Cancer, long after irradiation injury
has healed.
 MODULE-30: ULTRASONOGRAPHY - PRINCIPLES AND ITS
APPLICATION IN VETERINARY PRACTICE

Learning objectives

This module deals with

Principles of ultrasonography
Properties of ultrasound waves
Different modes of echo display

PRINCIPLES OF ULTRA SONOGRAPHY

Introduction

Medical sonography is the only diagnostic imaging modality that does not use
electromagnetic radiation. Modern ultrasound instruments are highly
sophisticated pieces of equipment. A basic understanding of the physics of
ultrasound, its interactions with tissue and the functions of the controls are
important while using the machines. In 1957 Ian Donald invented scanner
or diagnostic ultrasound.

What is ultrasound?

Sound waves of frequencies greater than audible to the human ear i.e
greater than 20- 20,000 Hz. is called Ultrasound waves. Diagnostic
ultrasound uses frequencies between 1 to 10 MHz
A sound wave travels in a pulse or a wave and when it is reflected back it
becomes an Echo and this pulse-echo principle, is used for ultrasound
imaging. A transducer is a device that converts one form of energy to
another. The piezoelectrical crystal in an ultrasound transducer
generates a pulse. When this crystal is stimulated electrically it changes
its shape and produces sound waves of a particular frequency.
Mechanical transducers are devices where the movement of crystals
suspended in a coupling medium generates ultrasound.where as
 electronic transducers also called array transducers do not have
intrernal coupling medium and are fired electronically.

How is ultrasound generated?

When a high voltage electrical current is applied crystals in the

transducer are vibrated and this is called piezo electric effect.
A sound wave travels in a pulse and when it is reflected back it becomes
an Echo.
It is this pulse-echo principle, which is used for ultrasound imaging. A
pulse is generated by one or more piezoelectrical crystal in an
ultrasound transducer.
When this crystal is stimulated electrically it changes its shape and
produces sound waves of a particular frequency.
As the transducer is placed in close contact with the body surface
through a coupling medium it undergoes continuous modification,
which occurs through three processes those are absorption, reflection
and scattering.
By means of the echo principle, an image can be produced on the
display of the scanner which relates to the acaustic independence of
tissues encountered by the ultrasound beam and the depth / distance of
tissue interfaces.

PROPERTIES OF ULTRASOUND WAVES

Frequency, wavelength and velocity are parameters used to describe the

sound waves.
Diagnostic ultrasound frequency ranges between 2 mega Hertz and 13
mega Hertz.
Wave length is the distance travelled by the sound in one cycle and is
expressed in millimeters and is important for image resolution.
Velocity is the rate at which sound travels through an acoustic medium.
As a rule it is greatest in solids, lower in liquids and lowest in
gases.Medically sound waves travel fastest in bone and slowest in gas
filled structures.
This causes a problem for diagnostic ultrasound machines, because they
use the average velocity of sound in soft tissue 1540m/s.

Interaction of ultrasound with matter

 Absorption: It occurs when the tissues absorb heat energy in the sound
beam. Absorption process forms the basis of therapeutic ultrasound.
Reflection: The reflection gives rise to an echo and forms the basis for
ultrasound scanning. Interfaces between tissues of different acoustic
impedence give rise to different echoes. These echoes are converted by
piezoelectric effect into electrical signals and displayed onto a
oscilloscope screen.
Scattering: It occurs when the beam encounters an interface that is
irregular and smaller than the sound beam. The portion of the beam
than interacts with this interface is scattered in all directions. Since the
scattering interfaces are small, only a small portion of the beam is
involved. Once the echoes are converted into electrical signals, these are
processed and transformed into a visual display of the measure of the
amplitude of the echo. This is known as echo quantification.

Generation of images on the display

Two basic shapes of ultrasound images are encountered: images made

in sector fashion are pie shaped and linear fashion are rectangular
Images are usually generated from the systemic scanner converter or
frame store which processes the reflected ultrasound in to a form
required for screen presentation.
Information is displayed regarding distance and amplitude. Each echo
position is represented as a dot on the screen. Thus a two dimensional
image is generated.
The brightness of each dot is related to the amplitude of the reflection
and is referred as a grey scale display.
Resolution is the ability of the ultrasound machines to distinguish
echoes on the basis of time, space and strength.
o Axial resolution: Ability to differentiate two objects lying closely
together in the direction of the beam.
o Lateral resolution: Ability to different the two objects lying side by
side. The ultrasound beam is refracted when it enters a tissue of
different acoustical density.
The image of refraction depends on the relative velocity of sound in the
two tissues.
Depth of sound wave penetration varies inversely with frequency.

DIFFERENT MODES OF ECHO DISPLAY

Different modes of echo display

Different modes of echo display are Brightness mode, B mode B scan

or grey scale used commonly for abdominal scanning and cardiac
imaging.
Static B mode: Transducer is moved in the scanning plane by hand.
 Real time B mode: Sound beam automatically and rapidly moves in the
scan plane. In this method the image is continuously updated to allow
movement.
Motion mode: Mmode mainly used for echocardiography.
A MODE or amplitude mode is simplest form of display. It displays two
parameters of the echoes in the form of spikes, ie., distance from the
transducer and the amplitude. The horizontal line shows the distance
and the amplitude is depicted on the vertical line. It is used for ocular
biometry.

Different types of basic probes

Linear curvilinear and sector probes

Transducers are classified based on the location of crystals on the scan
head. When elements are located at the end of the probe they are called
end fire transducers and they are used in abdominal and cardiac
scanning. Side fire trasducers are used for intracavity scanning like large
animal reproductive scanning.

Doppler ultrasonography

The pitch of a siren in a train changes with the proximity of the train
movement, due to difference in the sound wave frequency, called
Doppler shift, the principle used in imaging the direction and velocity of
blood flow. It was first proposed by Johann Christian Andreas Doppler
in 1842.
Four Doppler modes are used in medical ultra sonography. They are
Continous wave Doppler, pulsed wave Doppler colour Doppler and
power Doppler.

MODULE-31:- RADIATION THERAPY - PRINCIPLES, ISOTOPES

AND THEIR USES IN DIAGNOSIS AND THERAPY

Learning objectives

This module deals with

Radiation therapy and its methods

Complications 0f radiation therapy

RADIATION THERAPY - INTRODUCTION

Radiation therapy for the treatment of neoplasm of domestic animals

has been used since the discovery of X-ray. Dr. R. Eberlin was the first
to report on the use of radiotherapy in veterinary practice.
 Radiotherapy is usually indicated for localised solid neoplasms that
cannot be excised completely. It is not indicated if neoplasm has the
potential of high incidence of metastasis.
The other indication are :
1. When surgery is expected to or has already failed.
2. When the regional or distant metastasis not occurred.
3. When radical surgery is unable to remove whole of the neoplasm.
4. When bulk of the neoplasm needs reduction in size so that it can
subsequently be removed surgically.
Radiotherapy is not done by a single dose, rather multiple treatments
are given over a period of time, termed fractioned therapy. In animals, it
is usually in 10-12 fractions of a radiation dose of 4-5 Gy each time,
usually three times per week.

METHODS OF RADIOTHERAPY

Teletherapy

The radiation source is kept at a distance from the lesion. It is of four

types
o Superficial X-ray therapy: Given through X-ray machine with
energy range of 60-100 keV.
o Deep X-ray therapy: Given through X-ray machine with energy
range of 100- 200 keV.
o Super voltage therapy: Provided through (i) X-ray machine
having linear accelerator or betatron or cyclotron, (ii) isotropic X-
ray machine with cobalt or cesium. It is used in deep and
substantial lesions
o Particulate beam therapy: Electron, neutron or proton beam can
also be used as a mode of teletherapy.

Brachytherapy

It is the therapeutic use of radioisotope either within the interstitium or

on the surface of a neoplasm. The isotopes used are 198 Au , 60 Co, 125
K. Specific methods of brachytherapy are
o Interstitial brachytherapy: Sources of radiation are within the
interstitium of the neoplasm.
o Pliesotherapy: It is surface brachytherapy for superficial lesions.
o Systemic brachytherapy: 132 I and 32 P can be used systemically.
It is used in extensive lesions and specific malignant conditions.
 COMPLICATIONS OF RADIOTHERAPY

Complications of radiotherapy are

o Immediate (minute to days): epilation, erythema , hematological
depression and GI disturbances and chromosomal aberration.
o Latent (months to years): leukemia , life span shortening , cancer,
lethal gene expression etc.

MODULE-32: SCAN AND MRI - PRINCIPLES AND THEIR

APPLICATION

Learning objectives

This module deals with

Digital Radiography (DR)

Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Nuclear Medicine

DIGITAL RADIOGRAPHY (DR)

Basic principles

DR involves translating x-ray energy into an electric signal that is in

turn converted to digital data (numbers). The process may be direct,
indirect, or hybrid. In direct DR, the x-ray energy is converted directly
into an electrical signal. In indirect DR, the x-ray energy is first
converted to light by using a phosphorescent plate; the light is then
converted to an electrical pulse.
The data are recorded on a plate, which is connected to a computer, and
the x-ray image is available for viewing almost immediately after
exposure. It can then be stored or printed out. Hybrid radiographic
processes record the output of the phosphorescent plate with a system
 similar to that found in a digital camera. CR and DR systems have a
number of advantages compared with film screen systems.
The linear response of digital systems to the x-ray exposure means that
these systems are relatively forgiving of errors in radiographic
technique. However, the quality of DR images depends on software
processing to produce a degree of contrast that is familiar to the reader.
DR and CR images are stored on a computer hard drive and should be
saved as DICOM (Digital Imaging and Communication in Medicine)
files. Some form of backup device is recommended, ideally at another
location.
The images may be quite large files, but they can be easily transmitted to
a remote location for review by a radiologist or other specialist. These
images may be manipulated in multiple ways, including adjusting
brightness and contrast, applying sharpening filters, inverting the
image, and magnifying part or all of the image.

COMPUTED TOMOGRAPHY (CT)

Basic principles

CT is an imaging method that uses the principles of tomography.

Tomography is the demonstration of a slice through the body displayed
without interference from structures lying above or below the level
under examination.
CT uses x-rays generated by a high-output x-ray tube. The tube is
mounted on a gantry opposite a series of detectors. The tube and the
detectors rotate in unison around the subject under examination. A fan-
shaped beam of x-rays passes through the body at a predetermined
level.
The pattern of x-rays that reaches the detectors is recordeda
projection. The entire gantry assembly is then rotated slightly, and the
procedure is repeated, generating a new projection. A series of such
projections is obtained, completely encompassing the body under
examination.
A computer uses complex mathematical formulas to create an image
from the series of projections. This image represents a slice of the body
at the level under examination.
The advantage of CT is its ability to distinguish different types of soft
tissue, such as brain white and gray matter or liver and gallbladder. CT
 achieves this degree of contrast by being able to measure very fine
differences in the ability of tissues to stop x-rays passing through them.
CT images are digital, and a computer is used for viewing. The gray scale
can be adjusted to highlight specific features such as bone or soft tissue
(windowing). In CT imaging, tissues and structures are described in
terms of attenuation, which is a measure of the capacity of a tissue to
stop x-rays. Attenuation is equivalent to radiopacity in radiography. The
appearance of a tissue is defined in relation to some reference tissue or
its expected normal appearance. Thus isoattenuating means having the
same attenuation and would be displayed as the same shade of gray. If
the tissue attenuates or stops the x-rays less than the reference tissue or
less than expected, it is described as hypoattenuating and is portrayed
as a darker shade of gray.
The term hyperattenuating is used to describe tissues with more
attenuation than expected. These terms are relative rather than
absolute, and the reference tissue or structure is usually stated.
Superimposed structures are eliminated. Iodinated contrast agents such
as those used for myelography or excretory urography may be used by
intravenous injection.
Lesions with abnormal circulation may show marked contrast
enhancement after such injections. In viewing CT images, brightness
and contrast are adjusted to highlight specific structures. CT can resolve
far greater contrast than can be displayed on a monitor or appreciated
by the human eye. Therefore the gray scale of the image is adjusted to
assign useful grays to tissues with varying levels of attenuation, referred
to as the window.
A lung window will show detail within the lungs, but almost all other
structures appear white with little detail. A bone window will display
detail of skeletal structures such as cortex and trabeculae, whereas soft
tissues appear gray with little detail and lungs appear quite black. A soft
tissue window shows good contrast and detail within soft tissue
structures such as the liver.
Hepatic veins can be distinguished from the gallbladder and other soft
tissues, whereas bone appears white and lungs dark. CT may be used to
image almost any body part. Among the more common applications are
diseases of the nasal cavity, sinuses, and ears. It may also be used to
evaluate the spine, brain, joints, lungs, mediastinum, pleural cavity, and
abdominal masses

MAGNETIC RESONANCE IMAGING (MRI)

Basic principles

Unlike CT, no ionizing radiation is used in magnetic resonance imaging

(MRI). MRI uses hydrogen atoms to generate an image. Hydrogen is
universally distributed in the body, principally in water molecules.
 Hydrogen atoms are essentially spinning protons and have an electrical
charge. Each atom acts as a tiny bar magnet. Under normal
circumstances, these tiny magnets are arranged randomly.
MRI uses relatively strong magnetic fields, ranging from 0.05 to 3.0
tesla in clinical use. In a strong magnetic field, a small majority of the
protons will be forced to point in the direction of the field while
spinning at a specific rate.
A radio signal pulse at the same frequency as the spin of the protons will
knock them out of their equilibrium state. As the protons return to their
original state, they release energy in the form of a radio signal,
effectively an echo of the original pulse used to disturb the protons. This
signal is collected by a scanner, processed, and displayed.
Smaller gradient magnetic fields are used to localize signals from
specific blocks of tissue. Whereas CT offers good soft tissue detail, the
contrast seen with MRI is superb. Different sequences of radiopulses
can be used to emphasize different tissue characteristics. Manipulation
of the parameters such as the timing and duration of the radiopulse and
the interval before an echo is recorded is used to highlight tissue
features.
MRI has superb contrast resolution in soft tissues and is very sensitive
to changes such as edema and hemorrhage. Signal intensity is used to
describe the appearance of tissues in MRI, just as attenuation is in CT
imaging.
It is a relative measure of the radio signal generated by tissues in
response to the stimulating radio energy pulse. If something is termed
isointense, it has the same appearance as some reference tissuefor
example, a mass might be isointense to the gray matter of the brain.
Hypointense means less signal and appears darker,
whereas hyperintense means more signal and a brighter appearance. As
in CT, these terms are relative and must be defined in relation to the
expected normal appearance, reference tissue, or appearance before the
use of contrast.
Bones, ligaments, and tendons appear quite dark on all image sequences
because they have very little water content and therefore very little
hydrogen to generate a signal. Nonetheless, MRI can provide useful data
about these structures.
Like CT, MRI uses contrast agents that enhance lesion visibility.
However, in the case of MRI, the agents are based on gadolinium, which
alters the local magnetic field and changes signal intensity.
Lesions that accumulate gadolinium appear bright (hyperintense) with
some sequences. MRI is capable of distinguishing or resolving objects of
approximately 1 mm in size, which is termed spatial resolution. This is
similar to CT but compares poorly to radiographic systems, which can
resolve objects of 0.1 mm in size. MRI has excellent contrast, showing
different soft tissues as distinct shades of gray, which creates the
impression of much finer detail.
 Unlike CT, which is limited to images in the plane of the gantry, images
can be obtained in any plane, so slices can be varied infinitely to
highlight lesions. MRI applications include imaging disease of the
central nervous system, nasal cavity and sinuses, joints, and the
abdomen.

NUCLEAR MEDICINE (SCINTIGRAPHY)

Basic principles

Scintigraphy is a branch of nuclear medicine. It is an imaging technique

in which radionuclides (radioactive elements emitting gamma rays) are
administered to a subject.
The radionuclides are attached to chemicals to form
radiopharmaceuticals that accumulate in the tissue of interest.
Mostradiopharmaceuticals are analogues of physiologic substances or
biologic organic molecules. Their presence, and their concentration, can
be detected by gamma-ray detection equipmentusually a gamma ray
camera.
The gamma rays are converted by the camera into signals from which a
computer produces a digital format that is used to construct an image of
the area under examination. Nuclear medicine images are described in
terms of uptake of the radiopharmaceutical.
The degree of uptake is subjectively assessed in some techniques, while
in others quantitative analysis is performed. In this way normal and
abnormal tissues can be identified by the selective accumulation of the
radioactive substances within them.

MODULE - 33 :-

ECOCARDIOGRAPHY - PRINCIPLES AND ITS APPLICATION

Learning objectives

This module deals with

Doppler Ultrasound
Types of Doppler Ultrasound
Applications of Doppler Ultrasound

DOPPLER ULTRASOUND
 A Doppler ultrasound test uses reflected sound waves to see how blood
flows through a blood vessel. It helps to evaluate blood flow through
major arteries and veins, such as those of the legs and neck.
It can show blocked or reduced blood flow through narrowing in the
major arteries of the neck that could cause a stroke. It also can reveal
blood clots in leg veins (deep vein thrombosis, or DVT) that could break
loose and block blood flow to the lungs (pulmonary embolism).
During pregnancy, Doppler ultrasound may be used to look at blood
flow in an unborn baby (fetus) to check the health of the fetus.
During Doppler ultrasound, a handheld instrument (transducer) is
passed lightly over the skin above a blood vessel. The transducer sends
and receives sound waves that are amplified through a microphone. The
sound waves bounce off solid objects, including blood cells.
The movement of blood cells causes a change in pitch of the reflected
sound waves (called the Doppler effect). If there is no blood flow, the
pitch does not change.
Information from the reflected sound waves can be processed by a
computer to provide graphs or pictures that represent the flow of blood
through the blood vessels. These graphs or pictures can be saved for
future review or evaluation. See a picture of a Doppler ultrasound.

TYPES OF DOPPLER ULTRASOUND

The basic types of Doppler ultrasound are

"Bedside" or continuous wave Doppler: This type uses the change in

pitch of the sound waves to provide information about blood flow
through a blood vessel. The veterinarian listens to the sounds produced
by the transducer to evaluate the blood flow through an area that may
be blocked or narrowed. This type of ultrasound can be done at the
bedside in the hospital with a portable machine to provide a fast
estimate of the extent of blood vessel damage or disease.
Duplex Doppler: Duplex Doppler ultrasound uses standard ultrasound
methods to produce a picture of a blood vessel and the surrounding
organs. Also, a computer converts the Doppler sounds into a graph that
gives information about the speed and direction of blood flow through
the blood vessel being evaluated.
Color Doppler: Color Doppler uses standard ultrasound methods to
produce a picture of a blood vessel. Also, a computer converts the
Doppler sounds into colors that are overlaid on the image of the blood
vessel and that represent the speed and direction of blood flow through
the vessel. Power Doppler is a special type of color Doppler. Power
Doppler can get some images that are hard or impossible to get using
standard color Doppler. Power Doppler is most commonly used to
evaluate blood flow through vessels within solid organs.
 APPLICATIONS OF DOPPLER ULTRASOUND

Non-invasive
Generally painless
Does not use radiation
Can show if you have any blocked arteries in neck, arms, abdomen,
coronary arteries and limbs
Can show if you have any blood clots in the veins in limbs
Can show the amount and speed of blood flow in your veins and arteries
Can be used instead of some more invasive procedures further reading.

MODULE-34: PRINCIPLES AND APPLICATIONS OF

SCINTIGRAPHY, GAMMA CAMERA, XERORADIOGRAPHY AND
DOPPLER

Learning objectives-This module deals with- Nuclear Scintigraphy

NUCLEAR SCINTIGRAPHY

Scintigraphy ("scint," Latin scintilla, spark) is a form of diagnostic test

used in nuclear medicine, wherein radioisotopes (here called
radiopharmaceuticals ) are taken internally, and the emitted radiation is
captured by external detectors (gamma cameras) to form two-
dimensional images.
 The principle is based on the use of pharmaceutical labelled with
radioisotope which after entry into the blood stream get localised in
particular tissue or organ. Thus the localisation of radioisotope can be
detected by using camera due to emission of gamma rays. Most widely
used radioisotope is Technetium-99m. This isotope has the advantage of
a short half life of 6hrs and thus animal can be discharged next day after
the scan . in addition, radiation exposure is minimum.
The distribution of the labelled isotope can be detected by a gamma
camera or a hand held detector. In both the case sodium iodide crystalis
used which absorbs gamma rays emitted by the radioisotope from the
patient and converts it to light flashes. The light is converted to an
electrical impulse. This impulse is shown on a oscilloscope or converted
to an image. Image can be produced in colours or in a grey colour.
A scan appears as a image formed of dots. The interpretation is based on
the appearance of increased (hot spots) or decreased (cold spots)
radioactivity region. Active process produces hot spots where as cold
spots observed in case of abscess.
It is mainly used to detect functional disorders of kidney, liver , GI tract,
lungs thyroid glands etc. Using this technique it is easier to detect
localised increase or decrease in bone turn over as a result of trauma or
disease. Any inflammatory or pathological process that causes increased
bone activity can be diagnosed by scintigraphy. Usefull in diagnosing
occult lameness. It has also been used to study renal, cardiac, lung
functions , images of vertebral column and detecting the neoplasms.
Problems associated with scintigraphy are
1. Cost of the gamma camera
2. Precise and strict safety precautions required.
3. Non specificity to the aetiology and difficulty encountered some
times in interpreting the scan especially skeletal system.
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