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WSV18-0219
ANESTHESIOLOGY
TOP 5 TIPS FOR ANESTHESIA OF THE GERIATRIC PET
A. da Cunha1
1Louisiana State University, Veterinary Clinical Sciences, Baton Rouge, USA
5 TIPS FOR ANESTHESIA OF GERIATRIC PETS Anderson Favaro da Cunha, DVM, MS, Dipl.ACVAA
Professor and Chief, Veterinary Anesthesia and Analgesia
Department of Veterinary Clinical Sciences
School of Veterinary Medicine, Louisiana State University
Baton Rouge, Louisiana, USA
Age is not a disease therefore, when designing
an anesthetic protocol for a geriatric patient, the understanding of the whole physiological status is
more important than knowing their actual chronological age. Focus should be given to co-existing diseases
that leads to poor functional organ capacity, such as neurological, pulmonary, cardiac, renal, hepatic and endocrine diseases alone or in combination. A complete geriatric pre-op profile includes history, physical examination, thoracic radiography, ECG, blood work and echocardiography. History of CNS depression, polyuria/ polydipsia, exercise intolerance, arrhythmias, cyanosis, abnormal pulse quality, cardiac murmurs and/or syncope indicates a need for a more extensive pre-anesthetic evaluation. Even though the focus should be on the specific organ dysfunction of that specific patient, and each patient is unique, here are some general tips for your geriatric patient that needs sedation or general anesthesia:
1- Supplement oxygen for your patient! A minimum of
3 minutes of pre-induction oxygenation via facemask, followed by intra-op and post-anesthetic phases (including after extubation) prevents possible hypoxemia. During anesthesia, manual or mechanical intermittent positive pressure ventilation and oxygen monitoring
is recommended (pulsoximetry, capnography and
blood gas analysis). Assisted ventilation is often recommended to maintain both normal ventilation
(PCO2 between 35-45 mmHg) and oxygenation (PaO2 higher than 60mmHg). This recommendation is based on the common physiological changes observed in geriatric patients. They are: Weakening of the respiratory muscles, loss of elastic tissue, pulmonary fibrosis, increased airway resistance, decreased pulmonary diffusion capacity, decreased capillary blood volume and increased susceptibility to respiratory infections.
43RD WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND 9TH FASAVA CONGRESS
25-28 September, 2018 | Singapore
remission although possible becomes less likely. It may also be worthwhile testing for acromegaly early on,
given it is associated with insulin resistance thereby significantly decreasing the likelihood of remission. Acromegaly may be an underdiagnosed condition and has been recognised in 25 % of diabetic cats, where only 1 in 4 was phenotypical of the disease4. Treatment with insulin should be instituted for two weeks prior to testing for acromegaly.
References
1 Gostelow R, Forcada Y, Graves T Systematic review of feline diabetic remission: Separating fact from opinion. Vet J; 2014; 202; 208-221.
2. Zini E, Hafner M, Osto M Predictors of clinical remission in cats with diabetes mellitus. J Vet Intern Med; 2010; 24; 1314-1321.
3. Gottlieb S, Rand JS Marshall R et al. Glycemic status and predictors of relapse for diabetic cats in remission. J Vet Intern Med; 2015; 43; 245-249.
5. Niessen S J M, Forcada Y, Mantis P, et al. Studying cat (Felis catus) diabetes: Beware of the acromegalic imposter. PLoS One 2015; 10(5): e0127794.






































































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