Feline Anesthesia and Pain Management

Foreword xvii Contributors xix 1 Handling, Restraint, and Preanesthetic Assessment 1 Graeme Doodnaught and Paulo Steagall Introduction 1 Handling and Restraint 2 Preanesthetic Assessment 10 Risk Factors, Morbidity, and Mortality 12 Further Reading 14 2 Anatomy, Physiology, and Pharmacology 17 Bradley Simon and Paulo Steagall Introduction 17 Cardiovascular System 17 Respiratory System 22 Nervous System 25 Urinary System 27 Hepatic System 30 Endocrine System 31 Gastrointestinal System 32 Further Reading 33 3 Sedation and Premedication 35 Paulo Steagall Introduction 35 Drugs used for Sedation in Cats 36 Acepromazine 36 Benzodiazepines 39 Agonists of α 2 -Adrenergic Receptors 40 Anticholinergics 43 Opioids 44 Ketamine and Alfaxalone 45 Trazodone 45 Other Drugs 45 Further Reading 46 4 Injectable Anesthetics and Induction of Anesthesia 49 Paulo Steagall Introduction 49 General Considerations for Induction of Anesthesia 50 Drugs used for Induction of Anesthesia 51 Propofol 51 Alfaxalone 54 Dissociative Anesthetics (Ketamine and Tiletamine) 55 Barbiturates 57 Etomidate 59 Fentanyl plus Midazolam 60 Induction with Volatile Anesthetics 60 Total Intravenous Anesthesia (TIVA) 61 Infusion Devices 62 Injectable-only Protocols 62 Further Reading 64 5 Local Anesthetics and Loco-regional Techniques 67 Francesco Staffieri and Paulo Steagall Introduction 67 Physicochemical and Pharmacodynamic Properties of Local Anesthetics 68 Axons and Nerve Fibers 69 Pharmacokinetics 70 Factors Influencing Onset and Duration of Action 70 Metabolism 71 Adjuvants 71 Local Anesthetics 71 Adverse Effects 74 Techniques for Nerve Location 77 Local Anesthetic Techniques 78 Further Reading 85 6 Inhalation and Balanced Anesthesia 89 Bruno Pypendop Volatile Anesthetics 89 Halothane 90 Isoflurane 90 Sevoflurane 91 Desflurane 91 Balanced Anesthetic Techniques 92 Opioids 93 Ketamine 95 Nitrous Oxide 96 Lidocaine 97 Dexmedetomidine 98 Gabapentin 98 Balanced Anesthesia Summary 99 Breathing Systems 99 Further Reading 103 7 Monitoring 105 Daniel Pang Introduction 105 Clinical Monitoring using Physical Senses (“Hands On”) 106 Cardiovascular System 107 Respiratory System 112 Further Reading 121 8 Fluid Therapy 123 Peter Pascoe Introduction 123 Feline Physiology and Pathology with regard to Fluid Therapy 123 Fluids 125 Preoperative Preparation 129 Intraoperative Fluids 132 Postoperative Care 136 Further Reading 137 9 Anesthetic Management of Special Conditions 139 Paulo Steagall Introduction 139 Urethral Obstruction and Uroabdomen 139 Chronic Kidney Disease (CKD) 143 Hyperthyroidism 145 Hypertrophic Cardiomyopathy (HCM) 147 Neuroanesthesia 148 Diaphragmatic Rupture 151 Gastrointestinal Emergencies 153 Idiopathic Hepatic Lipidosis 154 Diabetes Mellitus 155 Other Conditions 156 Further Reading 157 10 Anesthetic Complications 159 Polly Taylor and Sheilah Robertson Introduction 159 Airway Management 161 Respiratory Insufficiency 167 Circulation 169 Trauma 173 Recovery 174 Body Temperature 176 Cardiopulmonary Resuscitation (CPR) 177 Further Reading 180 11 Mechanisms of Pain 183 Craig B. Johnson Introduction 183 Mechanisms of Modulation in Tissues 183 Mechanisms of Modulation in Peripheral Nerves 186 Mechanisms of Modulation in The Spinal Cord 188 Mechanisms of Modulation in the Brain 189 The Role of Glial Cells (Glia, Neuroglia) and the Immune System 191 Mechanisms of Cancer Pain 192 Diabetic Neuropathy 195 Pruritus (Itch) 196 Further Reading 197 12 Assessment and Recognition of Acute Pain 199 Sheilah Robertson Introduction 199 Pain-assessment Tools 199 Behavior-based Indicators of Pain 206 Intervention Scores 212 Using Response to Treatment as a Diagnostic Tool 212 Confounding Factors 212 Personality, Fear and Stress 213 Using Pain-assessment Tools 216 Continued Assessment at Home 216 Further Reading 217 13 Treatment of Acute (Adaptive) Pain 221 Paulo Steagall and Polly Taylor Introduction 221 Challenges in Feline Pain Management 222 Principles of Pain Management 223 Nonpharmacological Therapies in Acute Pain Management 227 Pharmacological Therapy in Acute Pain Management 229 Further Reading 237 14 Assessment and Recognition of Chronic (Maladaptive) Pain 241 Beatriz Monteiro and Duncan Lascelles Introduction 241 Common Causes of Chronic Pain 244 Clinical Signs 244 Implications for Quality of Life 246 The Concept of Analgesic Challenge 248 Assessing Chronic Pain in Specific Conditions 248 Further Reading 255 15 Treatment of Chronic (Maladaptive) Pain 257 Beatriz Monteiro and Eric Troncy Introduction 257 Client Communication: A Crucial Component of Treatment for Chronic Painful Conditions 258 Challenges in the Treatment of Chronic Pain in Cats 258 Pharmacological Therapy 261 Opioids 261 Local Anesthetics 261 Nonsteroidal Anti-inflammatory Drugs (NSAIDs) 263 Tramadol 267 Gabapentin 268 Amantadine 270 Emerging Analgesic Modalities 270 Other Analgesics 271 Nonpharmacological Treatment 272 Physical Activity and Weight Control 272 Physical Therapy, Massage, Acupuncture, and Transcutaneous Electrical Nerve Stimulation (TENS) 273 Monitoring for Treatment Efficacy 276 Degenerative Joint Disease (DJD) 276 Further Reading 278 Index 281