Question:
I notice that you generally don’t use ketamine, and ketamine is the specific drug I was warned away from, especially for my cat with chronic renal failure. So, what about cats with CRF?
Good question. Advanced renal disease with a low PCV would be the one time where I might consider complete isoflurane induction, if I feel cardiac function was ok. Ketamine is excreted by the kidneys so recovery is prolonged. Renal cats are more sensitive to thiopental and it causes sequestration of red blood cells in the spleen so I worry about the negative impact of this when the PCV is low. In less advanced renal cases I give a low dose of thiopental to partially anesthetize them and then complete induction by masking with isoflurane. Intravenous fluid therapy is VERY important when anesthetizing renal cats. J.
Response:
<< This is better than tank induction because the physical restraint required may prevent self trauma and its possible to monitor them more closely than while in a tank. J. I had heard that it was pretty difficult to mask a cat without any prior sedation as they will struggle against it. Do you think this type of masking using no sedation is preferable to the sedation you were talking about followed by an induction agent followed by iso or would you say both methods are equally safe? Lauren’s cats must have been very mellow to allow this. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
– Hide quoted text — Show quoted text – My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J. I never realized that there was an induction phase and then maintenance phase. guess I never really thought about it so I’m very grateful that you have brought up these issues. I got out my records for both my cats. For my male, Mickey’s neutering, it says: "Masked down with ISO/02 for orch. NT. Gave 0.15 ML torbugesic IM." For my female Meesha’s spay it says: "Masked and maintained on ISO/02 for OHE. Closed with GUT. Gave 0.3 ML Torbugesic IM." Can you please tell me what does this mean?
Your cats were induced and maintained with isoflurane and given butorphanol for pain control. Instead of tank induction the isoflurane was delivered to a conical mask that was held over their faces until they were unconscious. This is better than tank induction because the physical restraint required may prevent self trauma and its possible to monitor them more closely than while in a tank. J. – Hide quoted text — Show quoted text – Thanks again, Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J.
I never realized that there was an induction phase and then maintenance phase. guess I never really thought about it so I’m very grateful that you have brought up these issues. I got out my records for both my cats. For my male, Mickey’s neutering, it says: "Masked down with ISO/02 for orch. NT. Gave 0.15 ML torbugesic IM." For my female Meesha’s spay it says: "Masked and maintained on ISO/02 for OHE. Closed with GUT. Gave 0.3 ML Torbugesic IM." Can you please tell me what does this mean? Thanks again, Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
<< Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps, J. Thank you very much, Dr. Martin. I will print out your posts and discuss them with my vet. I do intend to request the IV fluids during surgery as well as all the monitoring. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
– Hide quoted text — Show quoted text – The most appropriate anesthetic protocol depends on the patient and what agents the vet is accustomed to using. For sedation and premedication I usually use a combination of butorphanol, acepromazine and glycopyrolate. Butorpahanol is a very safe albeit somewhat weak narcotic pain reliever. Acepromazine is a sedative and glyco is an anticholinergic which minimizes respiratory secretions and maintains an adequate heart rate. I leave the glyco out for most heart patients and I decrease or eliminate the ace with liver problems. For painful procedures in healthy animals I will often give injectable metacam (meloxicam) after surgery. Pain in debilitated animals is best managed with strong opiates (e.g. morphine, fentanyl patch). For induction I use thiopental most often. Thiopental is a an ultrashort acting barbiturate. I like it because at appropriate doses recovery is dependant on redistribution to the fat rather than liver metabolism or kidney excretion. I find I can usually use less than calculated doses to get a cat deep enough to intubate. For skinny cats I might use ketamine/valium or sometimes propofol. All pets are maintained on isoflurane. You will get different opinions about tank induction with isoflurane. I used to use this technique in high risk patients thinking it was a safer method of anesthesia and many other vets feel the same way. I’ve changed my thinking based on my own experiences and from what I’ve learned from anesthesiologists at conferences and on the internet.. I can’t say for certain but I would suspect that most anesthesiologists favour balanced anesthesia. Certainly tanking animals down was never done at the veterinary teaching hospital I graduated from. If you want safe anesthesia for your cat I would suggest requesting intraoperative IV fluids. Intra-op fluids allow for instantaneous venous access for IV injections of emergency drugs if needed. Fluids keep the kidneys perfused and can help maintain blood pressure even in the face of excessive blood loss. Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps,
I notice that you generally don’t use ketamine, and ketamine is the specific drug I was warned away from, especially for my cat with chronic renal failure. So, what about cats with CRF?
Response:
For skinny cats I might use ketamine/valium or sometimes propofol.
J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Response:
Duhhh, metabolic rates of the CATS I meant. Not of the substance…. hehe. — *When in doubt, See a Vet! – Nothing else substitutes for a professional.*
– Hide quoted text — Show quoted text – For skinny cats I might use ketamine/valium or sometimes propofol. J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Response:
For skinny cats I might use ketamine/valium or sometimes propofol. J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Recovery from thiopental depends on redistribution of the drug from the blood to the fat. Once the fat is saturated the remaining drug in the blood must be metabolized by the liver – a much slower process. Thus skinny animals (e.g. sight hounds) can have prolonged recoveries from thiopental. That’s why I use ket/val on skinny cats instead of thiopental. J. – Hide quoted text — Show quoted text –
Response:
What drugs do you recommend using for sedation and induction, and why?
See my response to MacCandace. J.
Response:
My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have
said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J.
Response:
Dr. Martin, what sedatives and induction agents do you use? Like others, I have heard that ketamine and telazol are hallucinogens and bad for cats. Is propofol the induction agent? I know that is widely used and considered very safe for humans. Please elaborate for us.
The most appropriate anesthetic protocol depends on the patient and what agents the vet is accustomed to using. For sedation and premedication I usually use a combination of butorphanol, acepromazine and glycopyrolate. Butorpahanol is a very safe albeit somewhat weak narcotic pain reliever. Acepromazine is a sedative and glyco is an anticholinergic which minimizes respiratory secretions and maintains an adequate heart rate. I leave the glyco out for most heart patients and I decrease or eliminate the ace with liver problems. For painful procedures in healthy animals I will often give injectable metacam (meloxicam) after surgery. Pain in debilitated animals is best managed with strong opiates (e.g. morphine, fentanyl patch). For induction I use thiopental most often. Thiopental is a an ultrashort acting barbiturate. I like it because at appropriate doses recovery is dependant on redistribution to the fat rather than liver metabolism or kidney excretion. I find I can usually use less than calculated doses to get a cat deep enough to intubate. For skinny cats I might use ketamine/valium or sometimes propofol. All pets are maintained on isoflurane. You will get different opinions about tank induction with isoflurane. I used to use this technique in high risk patients thinking it was a safer method of anesthesia and many other vets feel the same way. I’ve changed my thinking based on my own experiences and from what I’ve learned from anesthesiologists at conferences and on the internet.. I can’t say for certain but I would suspect that most anesthesiologists favour balanced anesthesia. Certainly tanking animals down was never done at the veterinary teaching hospital I graduated from. If you want safe anesthesia for your cat I would suggest requesting intraoperative IV fluids. Intra-op fluids allow for instantaneous venous access for IV injections of emergency drugs if needed. Fluids keep the kidneys perfused and can help maintain blood pressure even in the face of excessive blood loss. Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps, J.
Response:
I agree with you completely. I hate having to put a cat under using ISO only. It’s stressful to the cat when going under, as well as myself who has to hold the box and watch them thrash about. Another reason I hate ISO only, is that when they wake up, they wake up fast. And once again, they start thrashing about, completely unlike the cats that got the Ketamine/Valium. They are so completely gorked out, and at times in a completely hallucinating state which intensifies the pain. I definitely never want my cats to be ISO’d only, having witnessed what it does. Cindy
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
Ket-Val is a combo of Ketamine and Valium. It CAN be used alone to anesthetize animals having minor surgery, and is also used by some vets to do short surgeries, like neuters. I don’t recommend using it other than as induction to surgery. The small amount needed to immobolize an animal for intubation shouldn’t have any negative side effects, but if Ket-Val is ALL that is used, then some animals can have very bad reactions. In addition, because it needs to be processed by the liver, if an animal needs to be woken up from surgery for some emergency reason, that option is not there. The doctor must wait until the Ket-Val has gone through the animals system. This is why isoflurane is the optimal choice for most surgeries. The gas can be stopped instantaneously and the animal will begin to wake up. Kelly
Thanks for the explanation, Kelly. I really don’t like Ketamine and won’t allow my cats to have it. IMO it’s not worth the risk of what some cat’s have gone through with it. =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
<< I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM This is very interesting. I have always respected Dr. Martin’s opinion as a long-time poster on this NG and I think that a vet who willingly takes his own time, with no chance of monetary gain, to monitor a newsgroup and help animals for no ulterior motive is a very good source. It is troubling, though, because I am one of the ones who has been led to believe that Isoflurane alone is the safest way to go. My oldest cat had dental surgery 2 years ago when he was 13 and I was worried about him being anesthesized and internet research as well as my own vet’s advice indicated that was the safest way to go and that is what we did and he was fine. I did know about the box and I was concerned about him being in there and worried that he would be very freaked out but it seemed safer in the long run. What a drag, now I don’t know what to believe. My youngest cat needs to be spayed in a month or 2 and I was planning on requesting Iso alone but now I’m concerned about it. Dr. Martin, what sedatives and induction agents do you use? Like others, I have heard that ketamine and telazol are hallucinogens and bad for cats. Is propofol the induction agent? I know that is widely used and considered very safe for humans. Please elaborate for us. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
Dr. Martin said that he *does* recommend isoflurane, but not as the agent to induce the anesthesia procedure. Cathy — "Staccato signals of constant information…" ("The Boy in the Bubble") Paul Simon
– Hide quoted text — Show quoted text – Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. I have never heard of this box. Of course I am not a vet but I would like to hear from other people on this. What anesthesia do you recommend then? I personally have had a cat who had a horrible experience form a drug called Telazol. I also have had a couple of friends whose cats got Ketamine who had horrible reactions to it. My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. I am going to ask her though and see what she says. All I know is when I had my cats spayed and neutered, they were given Isoflurane. My female was also given a pain killer. Both of my cats came out of the anesthesia very quickly and I was able to take them home the same day. They were both alert and acting themselves. On the other hand, when our last cat had a dental cleaning, they used Telazol. She was hallucinating and couldn’t walk properly for 2 days. It was a horrible, horrible thing to see. I had told the vet our cat was very sensitive and that they should only give her a small amount of anesthesia. But instead they gave her way too much and the reaction was terrible. After that happened, we switched vets and the new vet said she would never have used Telazol on a cat. She doesn’t use Ketamine either, I believe. Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. What is Ket-Val?
I believe she is referring to Ketamine and Valium.
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. What is Ket-Val? Are you speaking about Ketamine? I just spent hours via telephone comforting a friend whose cat had a very bad reaction to
Ketamine. Ket-Val is a combo of Ketamine and Valium. It CAN be used alone to anesthetize animals having minor surgery, and is also used by some vets to do short surgeries, like neuters. I don’t recommend using it other than as induction to surgery. The small amount needed to immobolize an animal for intubation shouldn’t have any negative side effects, but if Ket-Val is ALL that is used, then some animals can have very bad reactions. In addition, because it needs to be processed by the liver, if an animal needs to be woken up from surgery for some emergency reason, that option is not there. The doctor must wait until the Ket-Val has gone through the animals system. This is why isoflurane is the optimal choice for most surgeries. The gas can be stopped instantaneously and the animal will begin to wake up. Kelly
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val.
What is Ket-Val? Are you speaking about Ketamine? I just spent hours via telephone comforting a friend whose cat had a very bad reaction to Ketamine. =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
I used to have a cat who would go in the box and give the dr. a dirty look, then hold his breath. The only thing he didn’t do was give the vet the finger. (The vet thought it was hilarious) Thanks for this info, however. I’m figuring my cat tomorrow will have to be put under for a tooth extraction and cleaning, so this is very timely for me. Juls
Response:
– Hide quoted text — Show quoted text – In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
What drugs do you recommend using for sedation and induction, and why?
Response:
Thanks, this is interesting. So, if one’s vet says they’re using isoflurane for a procedure, then I take it that most likely the initial stage(s) may be via other methods, with the main portion/ maintenance of the anesthesia being isoflurane? Cathy — "Staccato signals of constant information…" ("The Boy in the Bubble") Paul Simon
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma.
I have never heard of this box. Of course I am not a vet but I would like to hear from other people on this. What anesthesia do you recommend then? I personally have had a cat who had a horrible experience form a drug called Telazol. I also have had a couple of friends whose cats got Ketamine who had horrible reactions to it. My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. I am going to ask her though and see what she says. All I know is when I had my cats spayed and neutered, they were given Isoflurane. My female was also given a pain killer. Both of my cats came out of the anesthesia very quickly and I was able to take them home the same day. They were both alert and acting themselves. On the other hand, when our last cat had a dental cleaning, they used Telazol. She was hallucinating and couldn’t walk properly for 2 days. It was a horrible, horrible thing to see. I had told the vet our cat was very sensitive and that they should only give her a small amount of anesthesia. But instead they gave her way too much and the reaction was terrible. After that happened, we switched vets and the new vet said she would never have used Telazol on a cat. She doesn’t use Ketamine either, I believe. Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
Dr. Martin, I totally agree with your procedure, and the steps you describe are the exact same steps we use at the vets office I was employed at for many years. Animals were giving a pre-med first, allowed to sit for 10 minutes. Then they were removed from their cage, given a small amount of Ket-Val, and then intubated for surgery. I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. Hope I didn’t mislead any of the posters. Thank you for clearing this up. Kelly — *When in doubt, See a Vet! – Nothing else substitutes for a professional.*
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
I notice that you generally don’t use ketamine, and ketamine is the specific drug I was warned away from, especially for my cat with chronic renal failure. So, what about cats with CRF?
Good question. Advanced renal disease with a low PCV would be the one time where I might consider complete isoflurane induction, if I feel cardiac function was ok. Ketamine is excreted by the kidneys so recovery is prolonged. Renal cats are more sensitive to thiopental and it causes sequestration of red blood cells in the spleen so I worry about the negative impact of this when the PCV is low. In less advanced renal cases I give a low dose of thiopental to partially anesthetize them and then complete induction by masking with isoflurane. Intravenous fluid therapy is VERY important when anesthetizing renal cats. J.
Response:
<< This is better than tank induction because the physical restraint required may prevent self trauma and its possible to monitor them more closely than while in a tank. J. I had heard that it was pretty difficult to mask a cat without any prior sedation as they will struggle against it. Do you think this type of masking using no sedation is preferable to the sedation you were talking about followed by an induction agent followed by iso or would you say both methods are equally safe? Lauren’s cats must have been very mellow to allow this. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
– Hide quoted text — Show quoted text – My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J. I never realized that there was an induction phase and then maintenance phase. guess I never really thought about it so I’m very grateful that you have brought up these issues. I got out my records for both my cats. For my male, Mickey’s neutering, it says: "Masked down with ISO/02 for orch. NT. Gave 0.15 ML torbugesic IM." For my female Meesha’s spay it says: "Masked and maintained on ISO/02 for OHE. Closed with GUT. Gave 0.3 ML Torbugesic IM." Can you please tell me what does this mean?
Your cats were induced and maintained with isoflurane and given butorphanol for pain control. Instead of tank induction the isoflurane was delivered to a conical mask that was held over their faces until they were unconscious. This is better than tank induction because the physical restraint required may prevent self trauma and its possible to monitor them more closely than while in a tank. J. – Hide quoted text — Show quoted text – Thanks again, Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J.
I never realized that there was an induction phase and then maintenance phase. guess I never really thought about it so I’m very grateful that you have brought up these issues. I got out my records for both my cats. For my male, Mickey’s neutering, it says: "Masked down with ISO/02 for orch. NT. Gave 0.15 ML torbugesic IM." For my female Meesha’s spay it says: "Masked and maintained on ISO/02 for OHE. Closed with GUT. Gave 0.3 ML Torbugesic IM." Can you please tell me what does this mean? Thanks again, Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
<< Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps, J. Thank you very much, Dr. Martin. I will print out your posts and discuss them with my vet. I do intend to request the IV fluids during surgery as well as all the monitoring. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
– Hide quoted text — Show quoted text – The most appropriate anesthetic protocol depends on the patient and what agents the vet is accustomed to using. For sedation and premedication I usually use a combination of butorphanol, acepromazine and glycopyrolate. Butorpahanol is a very safe albeit somewhat weak narcotic pain reliever. Acepromazine is a sedative and glyco is an anticholinergic which minimizes respiratory secretions and maintains an adequate heart rate. I leave the glyco out for most heart patients and I decrease or eliminate the ace with liver problems. For painful procedures in healthy animals I will often give injectable metacam (meloxicam) after surgery. Pain in debilitated animals is best managed with strong opiates (e.g. morphine, fentanyl patch). For induction I use thiopental most often. Thiopental is a an ultrashort acting barbiturate. I like it because at appropriate doses recovery is dependant on redistribution to the fat rather than liver metabolism or kidney excretion. I find I can usually use less than calculated doses to get a cat deep enough to intubate. For skinny cats I might use ketamine/valium or sometimes propofol. All pets are maintained on isoflurane. You will get different opinions about tank induction with isoflurane. I used to use this technique in high risk patients thinking it was a safer method of anesthesia and many other vets feel the same way. I’ve changed my thinking based on my own experiences and from what I’ve learned from anesthesiologists at conferences and on the internet.. I can’t say for certain but I would suspect that most anesthesiologists favour balanced anesthesia. Certainly tanking animals down was never done at the veterinary teaching hospital I graduated from. If you want safe anesthesia for your cat I would suggest requesting intraoperative IV fluids. Intra-op fluids allow for instantaneous venous access for IV injections of emergency drugs if needed. Fluids keep the kidneys perfused and can help maintain blood pressure even in the face of excessive blood loss. Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps,
I notice that you generally don’t use ketamine, and ketamine is the specific drug I was warned away from, especially for my cat with chronic renal failure. So, what about cats with CRF?
Response:
For skinny cats I might use ketamine/valium or sometimes propofol.
J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Response:
Duhhh, metabolic rates of the CATS I meant. Not of the substance…. hehe. — *When in doubt, See a Vet! – Nothing else substitutes for a professional.*
– Hide quoted text — Show quoted text – For skinny cats I might use ketamine/valium or sometimes propofol. J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Response:
For skinny cats I might use ketamine/valium or sometimes propofol. J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Recovery from thiopental depends on redistribution of the drug from the blood to the fat. Once the fat is saturated the remaining drug in the blood must be metabolized by the liver – a much slower process. Thus skinny animals (e.g. sight hounds) can have prolonged recoveries from thiopental. That’s why I use ket/val on skinny cats instead of thiopental. J. – Hide quoted text — Show quoted text –
Response:
What drugs do you recommend using for sedation and induction, and why?
See my response to MacCandace. J.
Response:
My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have
said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J.
Response:
Dr. Martin, what sedatives and induction agents do you use? Like others, I have heard that ketamine and telazol are hallucinogens and bad for cats. Is propofol the induction agent? I know that is widely used and considered very safe for humans. Please elaborate for us.
The most appropriate anesthetic protocol depends on the patient and what agents the vet is accustomed to using. For sedation and premedication I usually use a combination of butorphanol, acepromazine and glycopyrolate. Butorpahanol is a very safe albeit somewhat weak narcotic pain reliever. Acepromazine is a sedative and glyco is an anticholinergic which minimizes respiratory secretions and maintains an adequate heart rate. I leave the glyco out for most heart patients and I decrease or eliminate the ace with liver problems. For painful procedures in healthy animals I will often give injectable metacam (meloxicam) after surgery. Pain in debilitated animals is best managed with strong opiates (e.g. morphine, fentanyl patch). For induction I use thiopental most often. Thiopental is a an ultrashort acting barbiturate. I like it because at appropriate doses recovery is dependant on redistribution to the fat rather than liver metabolism or kidney excretion. I find I can usually use less than calculated doses to get a cat deep enough to intubate. For skinny cats I might use ketamine/valium or sometimes propofol. All pets are maintained on isoflurane. You will get different opinions about tank induction with isoflurane. I used to use this technique in high risk patients thinking it was a safer method of anesthesia and many other vets feel the same way. I’ve changed my thinking based on my own experiences and from what I’ve learned from anesthesiologists at conferences and on the internet.. I can’t say for certain but I would suspect that most anesthesiologists favour balanced anesthesia. Certainly tanking animals down was never done at the veterinary teaching hospital I graduated from. If you want safe anesthesia for your cat I would suggest requesting intraoperative IV fluids. Intra-op fluids allow for instantaneous venous access for IV injections of emergency drugs if needed. Fluids keep the kidneys perfused and can help maintain blood pressure even in the face of excessive blood loss. Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps, J.
Response:
I agree with you completely. I hate having to put a cat under using ISO only. It’s stressful to the cat when going under, as well as myself who has to hold the box and watch them thrash about. Another reason I hate ISO only, is that when they wake up, they wake up fast. And once again, they start thrashing about, completely unlike the cats that got the Ketamine/Valium. They are so completely gorked out, and at times in a completely hallucinating state which intensifies the pain. I definitely never want my cats to be ISO’d only, having witnessed what it does. Cindy
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
Ket-Val is a combo of Ketamine and Valium. It CAN be used alone to anesthetize animals having minor surgery, and is also used by some vets to do short surgeries, like neuters. I don’t recommend using it other than as induction to surgery. The small amount needed to immobolize an animal for intubation shouldn’t have any negative side effects, but if Ket-Val is ALL that is used, then some animals can have very bad reactions. In addition, because it needs to be processed by the liver, if an animal needs to be woken up from surgery for some emergency reason, that option is not there. The doctor must wait until the Ket-Val has gone through the animals system. This is why isoflurane is the optimal choice for most surgeries. The gas can be stopped instantaneously and the animal will begin to wake up. Kelly
Thanks for the explanation, Kelly. I really don’t like Ketamine and won’t allow my cats to have it. IMO it’s not worth the risk of what some cat’s have gone through with it. =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
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<< I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM This is very interesting. I have always respected Dr. Martin’s opinion as a long-time poster on this NG and I think that a vet who willingly takes his own time, with no chance of monetary gain, to monitor a newsgroup and help animals for no ulterior motive is a very good source. It is troubling, though, because I am one of the ones who has been led to believe that Isoflurane alone is the safest way to go. My oldest cat had dental surgery 2 years ago when he was 13 and I was worried about him being anesthesized and internet research as well as my own vet’s advice indicated that was the safest way to go and that is what we did and he was fine. I did know about the box and I was concerned about him being in there and worried that he would be very freaked out but it seemed safer in the long run. What a drag, now I don’t know what to believe. My youngest cat needs to be spayed in a month or 2 and I was planning on requesting Iso alone but now I’m concerned about it. Dr. Martin, what sedatives and induction agents do you use? Like others, I have heard that ketamine and telazol are hallucinogens and bad for cats. Is propofol the induction agent? I know that is widely used and considered very safe for humans. Please elaborate for us. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
Dr. Martin said that he *does* recommend isoflurane, but not as the agent to induce the anesthesia procedure. Cathy — "Staccato signals of constant information…" ("The Boy in the Bubble") Paul Simon
– Hide quoted text — Show quoted text – Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. I have never heard of this box. Of course I am not a vet but I would like to hear from other people on this. What anesthesia do you recommend then? I personally have had a cat who had a horrible experience form a drug called Telazol. I also have had a couple of friends whose cats got Ketamine who had horrible reactions to it. My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. I am going to ask her though and see what she says. All I know is when I had my cats spayed and neutered, they were given Isoflurane. My female was also given a pain killer. Both of my cats came out of the anesthesia very quickly and I was able to take them home the same day. They were both alert and acting themselves. On the other hand, when our last cat had a dental cleaning, they used Telazol. She was hallucinating and couldn’t walk properly for 2 days. It was a horrible, horrible thing to see. I had told the vet our cat was very sensitive and that they should only give her a small amount of anesthesia. But instead they gave her way too much and the reaction was terrible. After that happened, we switched vets and the new vet said she would never have used Telazol on a cat. She doesn’t use Ketamine either, I believe. Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. What is Ket-Val?
I believe she is referring to Ketamine and Valium.
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. What is Ket-Val? Are you speaking about Ketamine? I just spent hours via telephone comforting a friend whose cat had a very bad reaction to
Ketamine. Ket-Val is a combo of Ketamine and Valium. It CAN be used alone to anesthetize animals having minor surgery, and is also used by some vets to do short surgeries, like neuters. I don’t recommend using it other than as induction to surgery. The small amount needed to immobolize an animal for intubation shouldn’t have any negative side effects, but if Ket-Val is ALL that is used, then some animals can have very bad reactions. In addition, because it needs to be processed by the liver, if an animal needs to be woken up from surgery for some emergency reason, that option is not there. The doctor must wait until the Ket-Val has gone through the animals system. This is why isoflurane is the optimal choice for most surgeries. The gas can be stopped instantaneously and the animal will begin to wake up. Kelly
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val.
What is Ket-Val? Are you speaking about Ketamine? I just spent hours via telephone comforting a friend whose cat had a very bad reaction to Ketamine. =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
I used to have a cat who would go in the box and give the dr. a dirty look, then hold his breath. The only thing he didn’t do was give the vet the finger. (The vet thought it was hilarious) Thanks for this info, however. I’m figuring my cat tomorrow will have to be put under for a tooth extraction and cleaning, so this is very timely for me. Juls
Response:
– Hide quoted text — Show quoted text – In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
What drugs do you recommend using for sedation and induction, and why?
Response:
Thanks, this is interesting. So, if one’s vet says they’re using isoflurane for a procedure, then I take it that most likely the initial stage(s) may be via other methods, with the main portion/ maintenance of the anesthesia being isoflurane? Cathy — "Staccato signals of constant information…" ("The Boy in the Bubble") Paul Simon
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma.
I have never heard of this box. Of course I am not a vet but I would like to hear from other people on this. What anesthesia do you recommend then? I personally have had a cat who had a horrible experience form a drug called Telazol. I also have had a couple of friends whose cats got Ketamine who had horrible reactions to it. My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. I am going to ask her though and see what she says. All I know is when I had my cats spayed and neutered, they were given Isoflurane. My female was also given a pain killer. Both of my cats came out of the anesthesia very quickly and I was able to take them home the same day. They were both alert and acting themselves. On the other hand, when our last cat had a dental cleaning, they used Telazol. She was hallucinating and couldn’t walk properly for 2 days. It was a horrible, horrible thing to see. I had told the vet our cat was very sensitive and that they should only give her a small amount of anesthesia. But instead they gave her way too much and the reaction was terrible. After that happened, we switched vets and the new vet said she would never have used Telazol on a cat. She doesn’t use Ketamine either, I believe. Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
Dr. Martin, I totally agree with your procedure, and the steps you describe are the exact same steps we use at the vets office I was employed at for many years. Animals were giving a pre-med first, allowed to sit for 10 minutes. Then they were removed from their cage, given a small amount of Ket-Val, and then intubated for surgery. I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. Hope I didn’t mislead any of the posters. Thank you for clearing this up. Kelly — *When in doubt, See a Vet! – Nothing else substitutes for a professional.*
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
I notice that you generally don’t use ketamine, and ketamine is the specific drug I was warned away from, especially for my cat with chronic renal failure. So, what about cats with CRF?
Good question. Advanced renal disease with a low PCV would be the one time where I might consider complete isoflurane induction, if I feel cardiac function was ok. Ketamine is excreted by the kidneys so recovery is prolonged. Renal cats are more sensitive to thiopental and it causes sequestration of red blood cells in the spleen so I worry about the negative impact of this when the PCV is low. In less advanced renal cases I give a low dose of thiopental to partially anesthetize them and then complete induction by masking with isoflurane. Intravenous fluid therapy is VERY important when anesthetizing renal cats. J.
Response:
<< This is better than tank induction because the physical restraint required may prevent self trauma and its possible to monitor them more closely than while in a tank. J. I had heard that it was pretty difficult to mask a cat without any prior sedation as they will struggle against it. Do you think this type of masking using no sedation is preferable to the sedation you were talking about followed by an induction agent followed by iso or would you say both methods are equally safe? Lauren’s cats must have been very mellow to allow this. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
– Hide quoted text — Show quoted text – My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J. I never realized that there was an induction phase and then maintenance phase. guess I never really thought about it so I’m very grateful that you have brought up these issues. I got out my records for both my cats. For my male, Mickey’s neutering, it says: "Masked down with ISO/02 for orch. NT. Gave 0.15 ML torbugesic IM." For my female Meesha’s spay it says: "Masked and maintained on ISO/02 for OHE. Closed with GUT. Gave 0.3 ML Torbugesic IM." Can you please tell me what does this mean?
Your cats were induced and maintained with isoflurane and given butorphanol for pain control. Instead of tank induction the isoflurane was delivered to a conical mask that was held over their faces until they were unconscious. This is better than tank induction because the physical restraint required may prevent self trauma and its possible to monitor them more closely than while in a tank. J. – Hide quoted text — Show quoted text – Thanks again, Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J.
I never realized that there was an induction phase and then maintenance phase. guess I never really thought about it so I’m very grateful that you have brought up these issues. I got out my records for both my cats. For my male, Mickey’s neutering, it says: "Masked down with ISO/02 for orch. NT. Gave 0.15 ML torbugesic IM." For my female Meesha’s spay it says: "Masked and maintained on ISO/02 for OHE. Closed with GUT. Gave 0.3 ML Torbugesic IM." Can you please tell me what does this mean? Thanks again, Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
<< Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps, J. Thank you very much, Dr. Martin. I will print out your posts and discuss them with my vet. I do intend to request the IV fluids during surgery as well as all the monitoring. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
– Hide quoted text — Show quoted text – The most appropriate anesthetic protocol depends on the patient and what agents the vet is accustomed to using. For sedation and premedication I usually use a combination of butorphanol, acepromazine and glycopyrolate. Butorpahanol is a very safe albeit somewhat weak narcotic pain reliever. Acepromazine is a sedative and glyco is an anticholinergic which minimizes respiratory secretions and maintains an adequate heart rate. I leave the glyco out for most heart patients and I decrease or eliminate the ace with liver problems. For painful procedures in healthy animals I will often give injectable metacam (meloxicam) after surgery. Pain in debilitated animals is best managed with strong opiates (e.g. morphine, fentanyl patch). For induction I use thiopental most often. Thiopental is a an ultrashort acting barbiturate. I like it because at appropriate doses recovery is dependant on redistribution to the fat rather than liver metabolism or kidney excretion. I find I can usually use less than calculated doses to get a cat deep enough to intubate. For skinny cats I might use ketamine/valium or sometimes propofol. All pets are maintained on isoflurane. You will get different opinions about tank induction with isoflurane. I used to use this technique in high risk patients thinking it was a safer method of anesthesia and many other vets feel the same way. I’ve changed my thinking based on my own experiences and from what I’ve learned from anesthesiologists at conferences and on the internet.. I can’t say for certain but I would suspect that most anesthesiologists favour balanced anesthesia. Certainly tanking animals down was never done at the veterinary teaching hospital I graduated from. If you want safe anesthesia for your cat I would suggest requesting intraoperative IV fluids. Intra-op fluids allow for instantaneous venous access for IV injections of emergency drugs if needed. Fluids keep the kidneys perfused and can help maintain blood pressure even in the face of excessive blood loss. Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps,
I notice that you generally don’t use ketamine, and ketamine is the specific drug I was warned away from, especially for my cat with chronic renal failure. So, what about cats with CRF?
Response:
For skinny cats I might use ketamine/valium or sometimes propofol.
J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Response:
Duhhh, metabolic rates of the CATS I meant. Not of the substance…. hehe. — *When in doubt, See a Vet! – Nothing else substitutes for a professional.*
– Hide quoted text — Show quoted text – For skinny cats I might use ketamine/valium or sometimes propofol. J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Response:
For skinny cats I might use ketamine/valium or sometimes propofol. J., How come only Ket/Val for skinny cats? What is the difference between giving a regular cat Ket/Val, and a skinny cat? Something to do with metabolic rates of the substance? Kelly
Recovery from thiopental depends on redistribution of the drug from the blood to the fat. Once the fat is saturated the remaining drug in the blood must be metabolized by the liver – a much slower process. Thus skinny animals (e.g. sight hounds) can have prolonged recoveries from thiopental. That’s why I use ket/val on skinny cats instead of thiopental. J. – Hide quoted text — Show quoted text –
Response:
What drugs do you recommend using for sedation and induction, and why?
See my response to MacCandace. J.
Response:
My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have
said. Isoflurane is an excellent anesthetic for maintenance of anesthesia its just not the best drug for inducing anesthesia. Your vet probably does use it. J.
Response:
Dr. Martin, what sedatives and induction agents do you use? Like others, I have heard that ketamine and telazol are hallucinogens and bad for cats. Is propofol the induction agent? I know that is widely used and considered very safe for humans. Please elaborate for us.
The most appropriate anesthetic protocol depends on the patient and what agents the vet is accustomed to using. For sedation and premedication I usually use a combination of butorphanol, acepromazine and glycopyrolate. Butorpahanol is a very safe albeit somewhat weak narcotic pain reliever. Acepromazine is a sedative and glyco is an anticholinergic which minimizes respiratory secretions and maintains an adequate heart rate. I leave the glyco out for most heart patients and I decrease or eliminate the ace with liver problems. For painful procedures in healthy animals I will often give injectable metacam (meloxicam) after surgery. Pain in debilitated animals is best managed with strong opiates (e.g. morphine, fentanyl patch). For induction I use thiopental most often. Thiopental is a an ultrashort acting barbiturate. I like it because at appropriate doses recovery is dependant on redistribution to the fat rather than liver metabolism or kidney excretion. I find I can usually use less than calculated doses to get a cat deep enough to intubate. For skinny cats I might use ketamine/valium or sometimes propofol. All pets are maintained on isoflurane. You will get different opinions about tank induction with isoflurane. I used to use this technique in high risk patients thinking it was a safer method of anesthesia and many other vets feel the same way. I’ve changed my thinking based on my own experiences and from what I’ve learned from anesthesiologists at conferences and on the internet.. I can’t say for certain but I would suspect that most anesthesiologists favour balanced anesthesia. Certainly tanking animals down was never done at the veterinary teaching hospital I graduated from. If you want safe anesthesia for your cat I would suggest requesting intraoperative IV fluids. Intra-op fluids allow for instantaneous venous access for IV injections of emergency drugs if needed. Fluids keep the kidneys perfused and can help maintain blood pressure even in the face of excessive blood loss. Proper monitoring is probably the most important aspect of safe anesthesia. A technician should keep track of anesthetic depth, heart rate and respiratory rate. Monitoring equipment such as respiratory, blood pressure, ECG and oxygen saturation monitors can also increase safety. Hope this helps, J.
Response:
I agree with you completely. I hate having to put a cat under using ISO only. It’s stressful to the cat when going under, as well as myself who has to hold the box and watch them thrash about. Another reason I hate ISO only, is that when they wake up, they wake up fast. And once again, they start thrashing about, completely unlike the cats that got the Ketamine/Valium. They are so completely gorked out, and at times in a completely hallucinating state which intensifies the pain. I definitely never want my cats to be ISO’d only, having witnessed what it does. Cindy
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
Ket-Val is a combo of Ketamine and Valium. It CAN be used alone to anesthetize animals having minor surgery, and is also used by some vets to do short surgeries, like neuters. I don’t recommend using it other than as induction to surgery. The small amount needed to immobolize an animal for intubation shouldn’t have any negative side effects, but if Ket-Val is ALL that is used, then some animals can have very bad reactions. In addition, because it needs to be processed by the liver, if an animal needs to be woken up from surgery for some emergency reason, that option is not there. The doctor must wait until the Ket-Val has gone through the animals system. This is why isoflurane is the optimal choice for most surgeries. The gas can be stopped instantaneously and the animal will begin to wake up. Kelly
Thanks for the explanation, Kelly. I really don’t like Ketamine and won’t allow my cats to have it. IMO it’s not worth the risk of what some cat’s have gone through with it. =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
<< I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM This is very interesting. I have always respected Dr. Martin’s opinion as a long-time poster on this NG and I think that a vet who willingly takes his own time, with no chance of monetary gain, to monitor a newsgroup and help animals for no ulterior motive is a very good source. It is troubling, though, because I am one of the ones who has been led to believe that Isoflurane alone is the safest way to go. My oldest cat had dental surgery 2 years ago when he was 13 and I was worried about him being anesthesized and internet research as well as my own vet’s advice indicated that was the safest way to go and that is what we did and he was fine. I did know about the box and I was concerned about him being in there and worried that he would be very freaked out but it seemed safer in the long run. What a drag, now I don’t know what to believe. My youngest cat needs to be spayed in a month or 2 and I was planning on requesting Iso alone but now I’m concerned about it. Dr. Martin, what sedatives and induction agents do you use? Like others, I have heard that ketamine and telazol are hallucinogens and bad for cats. Is propofol the induction agent? I know that is widely used and considered very safe for humans. Please elaborate for us. Candace (take the litter out before replying by e-mail) See my cats at www.gatherround.com Go to "Find an album." Password: GlenrosaCats
Response:
Dr. Martin said that he *does* recommend isoflurane, but not as the agent to induce the anesthesia procedure. Cathy — "Staccato signals of constant information…" ("The Boy in the Bubble") Paul Simon
– Hide quoted text — Show quoted text – Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. I have never heard of this box. Of course I am not a vet but I would like to hear from other people on this. What anesthesia do you recommend then? I personally have had a cat who had a horrible experience form a drug called Telazol. I also have had a couple of friends whose cats got Ketamine who had horrible reactions to it. My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. I am going to ask her though and see what she says. All I know is when I had my cats spayed and neutered, they were given Isoflurane. My female was also given a pain killer. Both of my cats came out of the anesthesia very quickly and I was able to take them home the same day. They were both alert and acting themselves. On the other hand, when our last cat had a dental cleaning, they used Telazol. She was hallucinating and couldn’t walk properly for 2 days. It was a horrible, horrible thing to see. I had told the vet our cat was very sensitive and that they should only give her a small amount of anesthesia. But instead they gave her way too much and the reaction was terrible. After that happened, we switched vets and the new vet said she would never have used Telazol on a cat. She doesn’t use Ketamine either, I believe. Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. What is Ket-Val?
I believe she is referring to Ketamine and Valium.
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. What is Ket-Val? Are you speaking about Ketamine? I just spent hours via telephone comforting a friend whose cat had a very bad reaction to
Ketamine. Ket-Val is a combo of Ketamine and Valium. It CAN be used alone to anesthetize animals having minor surgery, and is also used by some vets to do short surgeries, like neuters. I don’t recommend using it other than as induction to surgery. The small amount needed to immobolize an animal for intubation shouldn’t have any negative side effects, but if Ket-Val is ALL that is used, then some animals can have very bad reactions. In addition, because it needs to be processed by the liver, if an animal needs to be woken up from surgery for some emergency reason, that option is not there. The doctor must wait until the Ket-Val has gone through the animals system. This is why isoflurane is the optimal choice for most surgeries. The gas can be stopped instantaneously and the animal will begin to wake up. Kelly
Response:
I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val.
What is Ket-Val? Are you speaking about Ketamine? I just spent hours via telephone comforting a friend whose cat had a very bad reaction to Ketamine. =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
I used to have a cat who would go in the box and give the dr. a dirty look, then hold his breath. The only thing he didn’t do was give the vet the finger. (The vet thought it was hilarious) Thanks for this info, however. I’m figuring my cat tomorrow will have to be put under for a tooth extraction and cleaning, so this is very timely for me. Juls
Response:
– Hide quoted text — Show quoted text – In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
What drugs do you recommend using for sedation and induction, and why?
Response:
Thanks, this is interesting. So, if one’s vet says they’re using isoflurane for a procedure, then I take it that most likely the initial stage(s) may be via other methods, with the main portion/ maintenance of the anesthesia being isoflurane? Cathy — "Staccato signals of constant information…" ("The Boy in the Bubble") Paul Simon
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma.
I have never heard of this box. Of course I am not a vet but I would like to hear from other people on this. What anesthesia do you recommend then? I personally have had a cat who had a horrible experience form a drug called Telazol. I also have had a couple of friends whose cats got Ketamine who had horrible reactions to it. My vet is a feline only practice and I highly doubt they would use Isoflorane if it had all these risks and things you have said. I am going to ask her though and see what she says. All I know is when I had my cats spayed and neutered, they were given Isoflurane. My female was also given a pain killer. Both of my cats came out of the anesthesia very quickly and I was able to take them home the same day. They were both alert and acting themselves. On the other hand, when our last cat had a dental cleaning, they used Telazol. She was hallucinating and couldn’t walk properly for 2 days. It was a horrible, horrible thing to see. I had told the vet our cat was very sensitive and that they should only give her a small amount of anesthesia. But instead they gave her way too much and the reaction was terrible. After that happened, we switched vets and the new vet said she would never have used Telazol on a cat. She doesn’t use Ketamine either, I believe. Lauren =^..^= Mickey and Meesha: http://albums.photopoint.com/j/AlbumIndex?u=1278826&a=9501548 Instant Karma’s gonna get you, gonna knock you round the face, better get yourself together, darlin’, join the human race….. - John Lennon
Response:
Dr. Martin, I totally agree with your procedure, and the steps you describe are the exact same steps we use at the vets office I was employed at for many years. Animals were giving a pre-med first, allowed to sit for 10 minutes. Then they were removed from their cage, given a small amount of Ket-Val, and then intubated for surgery. I can remember myself telling people on this newsgroup to make sure that isoflurane gas be used during the surgery, but I always assumed that induction would by done intraveneously with Ket-Val. Hope I didn’t mislead any of the posters. Thank you for clearing this up. Kelly — *When in doubt, See a Vet! – Nothing else substitutes for a professional.*
– Hide quoted text — Show quoted text – I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
I have read countless times in this newsgroup that the ideal anesthesia in cats is isoflurane only. When the topic of anesthesia is brought up people are encouraged to request their cats be anesthetized with nothing but isoflurane. This has bugged me for a long time so I’ve decided to comment on it. Isoflurane only anesthesia involves placing a completely alert cat in a gas box and running isoflurane gas at maximum concentration for about 5 minutes until the cat is unconscious, then the cat is intubated and surgery begins. Isoflurane smells very bad and this procedure is extremely stressful for the cat. Its not uncommon for the terrified cats to flail around inside the small box trying to escape the noxious fumes. Not only is this disturbing to witness, it places the cat at risk of self inflicted trauma. It is this kind of prolonged intense stress that can cause a cat with asymptomatic heart disease to decompensate and go into heart failure. Isoflurane is a very safe anesthetic at regular concentrations but the high concentrations used for tank inductions can cause profound, life threatening hypotension (low blood pressure). Being in a sealed box the cat cannot be monitored closely enough during this critical period. The induction phase of anesthesia (before securing an airway with intubation) is the most dangerous. With gas induction we prolong what could be a 30 second induction to a 5 minute highly stressful induction. Also isoflurane provides no pain control. In my opinion ideal anesthesia consists of 3 stages. 1) sedation – an intramuscular or subcutaneous injection tha contains a sedative, an analgesic and sometimes a anticholinergic to maintain heart rate. Sedation allows for decreased doses of induction agent (safer). It also calms the patient to reduce stress and provides preemptive pain control. 2) induction – an intravenous agent that rapidly anesthetizes the patient so that an endotracheal tube can be rapidly placed so that we can breathe for the patient if the patient stops breathing. These agents act so fast that they can be dosed to effect – we only need to give as much as needed to make the patient fall asleep. In a high risk cardiac patient I may give a small amount of induction agent to calm and restrain the animal and finish with a short period of mask induction. 3) maintenance – I agree isoflurane is a desirable agent for maintenace. I hate the thought of many cats going through the stress and increased risk of gas induction because people are insisting on this form of anesthesia. J. Martin DVM
Response:
. Hope this helps. Empathetic purrs & best wishes Gordon & the TT Anyone else out there dealing with a similar back problem? Has physical therapy / exercise and anti-inflammatories helped at all? 
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sandy mccroskey brooklyn, ny 
I hope someone might be able to look at this and tell me if they see what I see? Insulin resistance = high red blood cell count Moderate/slight iron increase = insulin resistance = high red blood cell count ? Therefore .. meat eating = high red blood cell count ..? Diabetologia 2001 Oct;44(10):1232-7 New aspects of the insulin resistance syndrome: impact on haematological parameters. Barbieri M, Ragno E, Benvenuti E, Zito GA, Corsi A, Ferrucci L, Paolisso G Department of Geriatric Medicine and Metabolic Diseases, University of Naples, Italy. [Medline record in process] AIM/HYPOTHESIS: Previous studies have shown that insulin has an important in vitro role in the regulation of human erythropoiesis. We investigated whether in vivo hyperinsulinaemia/insulin resistance affects haematological parameters. METHODS: A total of 608 subjects between 22 and 99 years of age were enrolled in the Chianti study, an epidemiological study of factors affecting mobility in old age. The degree of insulin resistance was assessed using the homeostasis model. RESULTS: We found a correlation between insulin resistance and red blood cell count, (r = 0.14 p < 0.001), plasma haemoglobin (r = 0.16 p < 0.001), haematocrit (r = 0.15 p < 0.001) and plasma iron (r = 0.1 p < 0.05) concentrations. Red blood cell count was also associated with the other biological markers of insulin resistance syndrome. Subjects with higher insulin resistance (4 degrees quartile) had higher red blood cell count, plasma triglycerides and low density lipoproteins (LDL) cholesterol concentrations and lower high density lipoproteins (HDL) cholesterol concentrations then subjects at the lowest quartiles of insulin resistance. Insulin resistance and BMI were significant and independent predictors of red blood cell count even when the analysis was adjusted for age, sex, waist-to-hip ratio, plasma iron and drug intake. CONCLUSION/HYPOTHESIS: Our findings provide in vivo evidence of a relation between hyperinsulinaemia/insulin resistance, the main variables of insulin resistance syndrome and erythropoiesis. Increased red blood cell count could be considered as a new aspect of the insulin resistance syndrome that could contribute to the increased risk of developing cardiovascular problems. [Diabetologia (2001) 44: 1232-1237] PMID: 11692171, UI: 21549023 Save the above report in [Macintosh] [Text] format Order documents on this page through Loansome Doc <pre Br J Nutr 2001 Oct;86(4):515-9 Low iron status and enhanced insulin sensitivity in lacto-ovo vegetarians. Hua NW, Stoohs RA, Facchini FS Department of Medicine, Division of Nephrology, San Francisco General Hospital, San Francisco, CA, USA. [Medline record in process] The efficacy of insulin in stimulating whole-body glucose disposal (insulin sensitivity) was quantified using direct methodology in thirty lacto-ovo vegetarians and in thirty meat-eaters. All subjects were adult, lean (BMI <23 kg/m2), healthy and glucose tolerant. Lacto-ovo vegetarians were more insulin sensitive than meat-eaters, with a steady-state plasma glucose (mmol/l) of 4.1 (95 % CI 3.5, 5.0) v. 6.9 (95 % CI 5.2, 7.5; respectively. In addition, lacto-ovo vegetarians had lower body Fe stores, as indicated by a serum ferritin concentration (mg/l) of 35 (95 % CI 21, 49) compared with 72 (95 % CI 45, 100) for meat-eaters To test whether or not Fe status might modulate insulin sensitivity, body Fe was lowered by phlebotomy in six male meat-eaters to levels similar to that seen in vegetarians, with a resultant approximately 40 % enhancement of insulin-mediated glucose disposal Our results demonstrate that lacto-ovo vegetarians are more insulin sensitive and have lower Fe stores than meat-eaters. In addition, it seems that reduced insulin sensitivity in meat-eaters is amenable to improvement by reducing body Fe. The latter finding is in agreement with results from animal studies where, no matter how induced, Fe depletion consistently enhanced glucose disposal. PMID: 11591239, UI: 21475355 Save the above report in [Macintosh] [Text] format Order documents on this page through Loansome Doc Who loves ya. Tom — Jesus was a Vegetarian! http://www.nucleus.com/watchman Moses was a Mystic! http://www.nucleus.com/watchman/light.html 