AAHA Anesthesia Guidelines For Dogs And Cats*
VETERINARY PRACTICE GUIDELINESAAHA Anesthesia Guidelines for Dogs and Cats*Richard Bednarski, MS, DVM, DACVA (Chair), Kurt Grimm, DVM, MS, PhD, DACVA, DACVCP,Ralph Harvey, DVM, MS, DACVA, Victoria M. Lukasik, DVM, DACVA, W. Sean Penn, DVM, DABVP (Canine/Feline),Brett Sargent, DVM, DABVP (Canine/Feline), Kim Spelts, CVT, VTS, CCRP (Anesthesia)ABSTRACTSafe and effective anesthesia of dogs and cats rely on preanesthetic patient assessment and preparation. Patients should bepremedicated with drugs that provide sedation and analgesia prior to anesthetic induction with drugs that allow endotrachealintubation. Maintenance is typically with a volatile anesthetic such as isoflurane or sevoflurane delivered via an endotrachealtube. In addition, local anesthetic nerve blocks; epidural administration of opioids; and constant rate infusions of lidocaine,ketamine, and opioids are useful to enhance analgesia. Cardiovascular, respiratory, and central nervous system functions arecontinuously monitored so that anesthetic depth can be modified as needed. Emergency drugs and equipment, as well as anaction plan for their use, should be available throughout the perianesthetic period. Additionally, intravenous access and crystalloid or colloids are administered to maintain circulating blood volume. Someone trained in the detection of recovery abnormalities should monitor patients throughout recovery. Postoperatively attention is given to body temperature, level of sedation,and appropriate analgesia. (J Am Anim Hosp Assoc 2011; 47:377–385. DOI 10.5326/JAAHA-MS-5846)There are no safe anesthetic agents, there are no safe anesthetic procedures.There are only safe anesthetists.—Robert Smith, MDaIntroductionPreanesthetic EvaluationThe purpose of this article is to provide guidelines for anesthetizingThe preanesthetic patient evaluation identifies individual riskdogs and cats, which can be used daily in veterinary practice. Thisfactors and underlying physiologic challenges that contribute in-will add to the existing family of American Animal Hospital As-formation for development of the anesthetic plan. Factors to besociation (AAHA) guidelinesb and other references, such as theevaluated include the following:anesthesia monitoring guidelines published by the American·College of Veterinary Anesthesiologists (ACVA)c.History: Identify risk factors, including responses to previousanesthetic events, known medical conditions, and previous ad-This article includes recommendations for preanesthetic patientverse drug responses. Identify all prescribed and over-the-counterevaluation and examination, selection of premedication, inductionmedications (including aspirin) and supplements to avoid ad-and maintenance drugs, monitoring, equipment, and recovery.verse drug interactions.1In recognition of differences among practices, these guidelines are·Physical examination: A thorough physical examination maynot meant to establish a universal anesthetic plan or legal standardreveal risk factors, such as heart murmur and/or arrhythmiaof care.or abnormal lung sounds.From the Veterinary Medical Center, The Ohio State University,Columbus, OH (R.B.); Veterinary Specialist Services PC, Conifer,CO (K.G.); Department of Small Animal Clinical Sciences, Universityof Tennessee College of Veterinary Medicine, Knoxville, TN (R.H.);Southwest Veterinary Anesthesiology, Southern Arizona VeterinarySpecialists, Tucson, AZ (V.L.); Phoenix, AZ (W.S.P.); Front RangeVeterinary Clinic, Lakewood, CO (B.S.); and Peak Performance Veterinary Group, Colorado Springs, CO (K.S.)AAHA American Animal Hospital Association; ACVA American College ofCorrespondence: richard.bednarski@cvm.osu.edu (R.B.)are all of Journal of American Animal Hospital Association articles.ª 2011 by American Animal Hospital AssociationVeterinary Anesthesiologists; ASA American Society of Anesthesiologists;AVMA American Veterinary Medical Association; ET endotracheal; PLIT Professional Liability Insurance Trust*This report was prepared by a task force of experts convened by theAmerican Animal Hospital Association for the express purpose of producingthis article. This report was sponsored by an educational grant from AbbottAnimal Health, and was subjected to the same external review process asJAAHA.ORG377
··Age: Advanced age can increase anesthetic risk because ofbased on the previously mentioned factors, as well as any change inchanges in cardiovascular and respiratory function. Disease pro-patient status or the presence of concurrent disease.cesses occur more commonly in aged patients. Very youngCategorization of patients using the American Society ofpatients can be at increased risk from hypoglycemia, hypother-Anesthesiologists (ASA) Patient Status Scale provides a frameworkmia, and decreased drug metabolism.for evaluation (Table 1). Patients with a higher ASA status are atBreed: Few breed-specific anesthesia issues are documented.greater risk for anesthetic complications and require additionalBrachycephalic dogs and cats are more prone to upper airwayprecautions to better ensure a positive outcome.3Client communication is important at all times, but espe-obstruction. Greyhounds have longer sleep times after receivingd·some anesthetics such as propofol or thiopental . Some breeds ofcially before anesthetic procedures. Obtain written informeddogs (e.g., Cavalier King Charles spaniel) and cats (e.g., Maineconsente after discussing the patient assessment and risks, thecoon) may be predisposed to cardiac disease as they age.2proposed anesthetic plan, and any available medical or surgicalTemperament: An aggressive or fractious temperament mayalternatives with the client. Include such information in in-pose a danger to staff and can limit the preanesthetic evaluationformed consent documents as guided by local and state regu-or make examination impossible. The selection of an alterna-latory agencies.4tive preanesthetic drug or drug combination may be required·for the aggressive or overly fearful animal due to the need forIndividual Planhigher-than-usual drug doses. Conversely, a quiet or depressedPatient Preparationanimal may benefit from lower doses for sedation or anesthesia.Before the day of surgery, communicate with the client about howType of procedure: Evaluate the procedure’s level of invasiveness,to prepare the pet for anesthesia, such as any recommendedanticipated pain, risk of hemorrhage, and/or predisposition tochanges in administration of medications. Allow free access tohypothermia. Some procedures may limit physical access to thewater (which may be allowed until the time of premedication).Recommend fasting before anesthesia to reduce the risk ofpatient for monitoring.··Using heavy sedation versus general anesthesia: This choiceregurgitation and aspiration, understanding that gastric emptyingdepends on the procedure, patient temperament, and the needtimes vary widely among individual patients and with the con-for monitoring and support. In general, sedation may be ap-tents of the food ingested.5 Young animals require shorter fastingpropriate for shorter (,30 min) and less-invasive procedurestimes. Food should not be withheld for .4 hr before surgery(e.g., diagnostic procedures, joint injections, suture removal,for those from 6 wk to 16 wk of age due to the risk of peri-and wound management). Sedated patients, just as those underoperative hypoglycemia. Although there is evidence to suggestgeneral anesthesia, require appropriate monitoring and sup-that shorter fasting times (,6 hr) might be sufficient to decreaseportive care. They may require airway management and/orthe risk of regurgitation for those .16 wk of age, overnightO2 supplementation. Be prepared to intubate if necessary.fasting is recommended for procedures scheduled earlier in theExperience and qualifications of personnel: Previous trainingday.6in local and regional anesthesia techniques will facilitate theirWith emergency procedures, fasting is often not possible, thusperioperative use. Also, a more experienced surgeon may beattention to airway management is critical. Do not delay emer-faster and cause less tissue trauma to a patient than a less expe-gency procedures when the benefit of the procedure outweighs therienced one.benefit of fasting.Risk factors and individual patients’ needs provide a framework for developing individualized patient plans and may indicatethe need for additional diagnostic testing or stabilization beforeTABLE 1anesthesia.ASA Physical Status Classification SystemIndividual practice procedures may include a minimumdatabase of laboratory analysis, electrocardiogram, and diagnostic1. Normal healthy patient2. Patient with mild systemic diseaseimaging for different patient groups. There is no evidence to in-3. Patient with severe systemic diseasedicate the minimum time frame before anesthesia within whichlaboratory analysis should be performed. However, the timingshould be reasonable to detect changes that impact anesthetic risk.The type and timing of such testing is determined by the veterinarian378JAAHA 47:6 Nov/Dec 20114. Patient with severe systemic disease that is a constant threat to life5. Moribund patient who is not expected to survive without the operationBased on the Physical Status Classification System of the American Society ofAnesthesiologists, 520 N Northwest Highway, Park Ridge IL 60068-2573; www.asahq.org. ASA, American Society of Anesthesiologists.
Veterinary Practice Guidelinesthe veterinarian’s preference and anticipation of procedure time.Anesthetic Management of Patientswith ComorbiditiesAdjust insulin administration accordingly with food intake. Re-Certain conditions require modification of the anesthetic protocol.gardless of how the patient has been fasted, manage the airway ofExtensive discussion of the anesthetic management of the diseasedevery patient as if its stomach were full.patient is beyond the scope of these guidelines. However, briefDiabetic patients may or may not be fasted depending onmention of diabetes, renal, cardiac, and hepatic disease is warranted.Anesthetic PlanCreate an individualized plan for patient management basedDiabeteson the anesthetic risks identified in the preanesthetic evalua-Perform periodic blood glucose measurements at sufficient in-tion, understanding that no single plan is appropriate fortervals throughout the perianesthetic period to detect hypogly-all patients. Resources such as staffing, equipment, and drugcemia or hyperglycemia before it becomes severe. Ideally, diabeticavailability also influence plan development. A complete an-patients should be well regulated before anesthesia induction unlessesthetic plan addresses perioperative analgesia, pre- and post-the procedure cannot be delayed.anesthetic sedation and/or tranquilization, induction andmaintenance drugs, ongoing physiologic support, monitor-Renal Diseaseing parameters, and responses to adverse events. The planNo one anesthetic drug or drug combination is better for renalshould be flexible to allow for dynamic patient responses duringdisease; most important is to maintain blood pressure and adequateanesthesia.renal perfusion. Diuresis of moderately or severely azotemic patientsbefore anesthetic induction may be warranted. Base the specific fluidPreanesthetic Medicationtypes and rates on patient condition and response, but generallyThe advantages of preoperative sedation and analgesia include1.5–2 times maintenance crystalloid administration for the 12–lowered patient and staff stress, ease of handling, and reduction of24 hr before anesthesia will reduce the magnitude of the azotemia.induction and inhalant anesthetic doses, most of which have dose-Continue fluids into the postoperative period as patient needsdependent adverse effects.dictate. Fluid rates up to 20–30 mL/kg/hr during anesthesia haveThere can be disadvantages to the administration of prean-been recommended in patients with renal dysfunction.10,11esthetic medications, such as dysphoria related to benzodiazepines,Patients with renal insufficiency may benefit from mannitol-bradycardia related to a-2 agonists and opioids, and hypotensioninduced diuresis and the associated increased renal medullaryrelated to acepromazine. These disadvantages can be mitigated byperfusion.12,13 To be effective, low-dose mannitol must be givenappropriate dosing and selecting the right combination of drugsbefore the ischemic episode; at higher doses it can cause renalfor the individual. Patients in critical condition may not requirevasoconstriction.any premedication.Vasopressors and inotropes have been recommended, butstrictly to maintain cardiac output. It has not been concluded thatPain Managementthey contribute to increased renal perfusion or renal protection.Choose drugs and techniques that provide both intraoperativeand postoperative analgesia. Because there is a high variability inCardiac Diseasepatient response to sedation and analgesia, individually tailor theIn patients with severe cardiac disease, carefully titrate IV fluidsmedication type, dose, and frequency based on the anticipatedto avoid inducing congestive heart failure from fluid overload.intensity and duration of pain. In addition to opioid premed-Patients will vary in how much fluid and at what rate they canication, perioperative analgesic techniques include nonsteroi-tolerate. Guide fluid administration by monitoring any of thedal anti-inflammatory drugs, local and regional nerve blocks, asfollowing: systemic blood pressure, central venous pressure, oxy-well as IV infusions of opioids, N-methyl-D-aspartate receptorgenation, or auscultation of lung sounds.antagonists (e.g., ketamine), and/or lidocaine. Multiple analgesicPreoperatively evaluate cardiac arrhythmias for considerationtechniques should be considered for more painful procedures.of perianesthetic treatment. Cardiac medications should be ad-Frequently reassess patient comfort and adjust pain managementministered normally the day of surgery. Some medications mayas needed. The AAHA Pain Management Guidelines and manypotentiate hypotension (e.g., angiotensin-converting enzyme in-other sources provide descriptions of and suggestions for painhibitors and b blockers). Be prepared to administer inotropes ormanagementf.7–9other supportive measures if needed.14JAAHA.ORG379
Opioid analgesics are useful during anesthesia of the patientanticholinergics to reduce the magnitude of bradycardia and as-with cardiovascular compromise. Certain anesthetic medicationssociated drop in cardiac output. However, the combination cre-may be less appropriate in some types of cardiac disease (e.g., atates the potential for myocardial hypoxemia to develop as a resulthigher doses, ketamine may increase heart rate, which could be aof increased myocardial work. Use of anticholinergics should beproblem in patients with hypertrophic cardiomyopathy; avoid a-2based on individual patient risk factors and monitored parametersagonists in dogs with mitral valve disease).15 A multimodal ap-such as heart rate and blood pressure.20,21proach using drugs from multiple pharmacologic categories is preferred to minimize extreme cardiovascular effects of any one drug.16Anesthesia PreparationEnsure that all equipment and medications deemed necessary forLiver Diseasethe procedure to be performed are readily accessible and inTrue liver dysfunction also warrants special attention; however,working order before induction of anesthesia. Regularly ensureincreases in the liver enzymes of an otherwise healthy patient areproper maintenance and function of all anesthetic equipment.not an absolute reason to avoid anesthesia. In patients with liverTable 2 provides a convenient maintenance checklist. Have emer-dysfunction, hypoglycemia can be a concern due to insufficientgency supplies and protocols available before any anesthetic pro-glycogen storage and impaired gluconeogenesis. Dextrose sup-cedure (e.g., tracheal suction; emergency lighting in the event ofplementation may be necessary. If hypoproteinemia is present,power failure). Conspicuously post a chart of emergency drugthe administration of fresh frozen plasma may be warranted. Indoses or preemptively calculate such doses for each patient. Famil-general, delayed anesthetic recovery can be expected with the useiarize yourself with the most current recommendations for car-of any anesthetic agent metabolized by the liver. Therefore, in-diopulmonary cerebral resuscitation and stock appropriate drugs.halants and drugs with specific antagonists such as opioids and a-2Useful emergency drug dose charts are available in many texts andagonists can be useful.also from the Veterinary Emergency and Critical Care Society g.Prepare a written anesthetic record for each patient, beginningAreas of Controversywith preparation for the anesthetic event and continuing throughThe authors recognize that opinions vary regarding the admin-the recovery period. Record preanesthetic patient status and allistration of certain perianesthetic drugs. Some of these are brieflyperianesthetic events, including drugs and dosages administered,outlined here.routes of administration, patient vital signs, events, and interven-There are misconceptions about the effects of acepromazine intions. Record resuscitation orders in the anesthetic record at the timepatients with seizure history. There is no evidence to show thatconsent is obtained. Regularly record patient parameters at 5–10 minacepromazine increases the risk of seizures in epileptic patients orintervals, or more frequently if sudden changes in physiologic statuspatients with other seizure disorders.17,18occur. An anesthetic record template is available from AAHAh.Indiscriminant use of anticholinergic drugs such as atropineand glycopyrrolate as part of a premedication protocol is con-Patient Preparationtroversial. Some think they should not be used routinely becausePreparing a patient for anesthesia may include some or all of thethe action will be short, and they may cause tachycardia, whichfollowing:increases myocardial O2 consumption and the potential for myo-·cardial hypoxemia.Inserting an IV catheter and administering IV fluids. This helpsto avoid perivascular administration of induction drugs. It facil-In contrast, the pre-emptive use of anticholinergics may beitates intravascular volume support, which may correct hypo-indicated for procedures with an increased risk of vagal bra-volemia resulting from vasodilation and blood loss that candycardia (e.g., ocular surgery) as well as in conjunction withoccur during surgery. It also allows for rapid administrationopioid administration, to offset the potential bradycardic effectsof emergency medications.of the opioid. Anticholinergics may also be indicated in dogs·Connecting monitoring equipment appropriate for the diseasewith brachycephalic syndrome, which is associated with air-condition present and that the patient will tolerate before in-way obstruction and higher resting vagal tone, making theseduction (Table 3).dogs more prone to developing bradycardia than are otherbreeds.19·Stabilizing hemodynamically unstable patients, including butnot limited to:The simultaneous use of anticholinergics with a-2 agonists· Administering IV fluid boluses. Hypovolemic patients mayhas been debated. Some practitioners prefer to administerrequire isotonic crystalloids, colloids, and/or hypertonic380JAAHA 47:6 Nov/Dec 2011
Veterinary Practice GuidelinesTABLE 2Anesthetic Equipment Check ListCO2 absorbentChange the CO2 absorbent regularly based on individual anesthesia machine manufacturer recommendations.The useful lifespan of absorbent varies with the patient size and fresh gas flow rate.OxygenEnsure supply lines are attached.Color change is not always an accurate indicator of remaining absorption capacity.Ensure the flowmeter is functioning.Ensure the supply tank and at least one spare tank is sufficiently full.To calculate the estimated remaining tank volume, follow this example: An E-cylinder contains 660 L, and has afull-pressure of 2,200 psi. Pressure drop is proportional to remaining O2 volume. A tank with 500 psi has 150 L.When used at a flow rate 1 L/min, it will last approximately 2 ½ hr.22Endotracheal tubes and masksHave access to various sizes of masks and endotracheal tubes.Provide a light source such as a laryngoscope.Check cuff integrity and amount of air needed to properly inflate the cuff.Breathing systemRefer to anesthesia machine’s documentation for proper leak-checking procedures.Conduct a check before every procedure.Select the appropriate size and type of reservoir bag and breathing circuit.23Non-rebreathing systems are generally used in patients weighing less than 5–7 kg or when the work ofbreathing associated with the circle system might not be easily sustainable by an individual patient.24InhalantEnsure vaporizer is sufficiently full.Waste scavenging equipmentVerify a functioning scavenging system.If using a charcoal absorbent canister, ensure there is sufficient capacity remaining for the duration of the procedure.Observe all regulations concerning the dispersion of waste anesthesia gases.25,26Electronic monitoring equipmentEnsure devices are operational and either connected to a power source or have adequate battery reserve.Check alarms for limits and activation.saline to improve vascular filling, cardiac output, and tissue perfusion.·Preoxygenation reduces the risk of hemoglobin desaturationand hypoxemia during the induction process. Preoxygenation· Managing cardiac arrhythmias.· Providing blood products. Hypoproteinemia, anemia, oris especially beneficial if a prolonged or difficult intubation iscoagulation disorders can aggravate the decreased deliveryoxygenation. However, preoxygenation may be contraindicatedof O2 to the tissues that normally occurs as a result ofif it agitates the patient. Removing the rubber diaphragm fromhypoventilation and recumbency.the facemask may increase patient tolerance of the mask.29expected or if the patient is already dependent on supplementalTABLE 3Anesthesia Monitoring ToolsElectrocardiogramPulse oximeter (SpO2)Arterial blood pressure monitorDirect intraarterial BP: Most accurate, but technically difficult to performNoninvasive BP (Doppler or oscillometric monitor): Technically easy, but can be inaccurate.27,28 Evaluate trends in conjunction with other patient parameters. Select cuffwidth of 40–50% of circumference of limb.Thermometer: Esophageal probe or periodic rectal temperature with conventional thermometerAnesthetic gas analyzer (measures inspired and expired inhalant concentration)Capnometer/capnograph (measures and/or displays CO2 in expired and inspired gas, and respiratory rate)Physical observationsVisualization (e.g., eye position, mucous membranes, chest excursion, blood loss, bag volume, and movement with ventilation, equipment function)Palpation (e.g., pulse quality, jaw tone, palpebral reflex)Auscultation (heart, lungs): Precordial or esophageal stethoscopeBP, blood pressure; SpO2, saturation level of O2.JAAHA.ORG381
Once the patient is as stable as possible, proceed according tothe individual patient plan.O2 flow rates depend on the breathing circuit used. Fora circle rebreathing system, use a relatively high flow rate whenrapid changes in anesthetic depth are needed, such as during theAnesthetic Inductiontransition from injectables to inhalants (induction) or whenAnesthetic induction is best achieved using rapid-acting IV drugs,turning the vaporizer off at the end of the procedure. During thealthough this may not always be a reasonable option for fractiousmaintenance phase, total O2 flow rate should typically be betweenpatients. IV induction allows for rapid airway control and allows200 and 500 mL. The system must be leak free for these flow ratesfor titration of the induction drug to effect within the givento be effective. These are, perhaps, lower O2 flow rates than manydosage range. Sick, debilitated, or depressed patients will requireare accustomed to. The benefits of lower flow rates include de-less drug than healthy, alert patients. A patient’s response to pre-creased environmental contamination and the economy of de-30anesthetic drugs can influence the amount and type of inductioncreased consumption of O2 and volatile anesthetic gases. Lowerdrug needed.flow rates also conserve moisture and heat. Disadvantages toMask or chamber inductions can cause stress, delayed air-lower flow rates include increased times to change anestheticway control, and environmental contamination.31 Adequate roomdepth. Administer an O2 flow of approximately 200 mL/kg/min toventilation must be present to minimize exposure to personnel.patients connected to a non-rebreathing circuit.22Reserve these techniques for situations where other alternativesGuidelines for anesthesia monitoring are available fromThe American College of Veterinary Anesthesiologists (ACVA).35are not suitable.Ensure endotracheal (ET) tubes and intubation aids (e.g.,Continue the cardiovascular monitoring and physiologic supportstylets, laryngoscope) are readily available. Establish and maintainmeasures that began in the patient preparation and/or inductiona patent airway using an ET tube as soon as possible. Use the largestperiods. Monitoring includes evaluation of oxygenation, ventila-diameter ET tube that will easily fit through the arytenoid cartilagestion, cardiac rate and rhythm, adequacy of anesthetic depth, musclewithout damaging them; this will minimize resistance and the workrelaxation, body temperature, and analgesia. Blood pressure, heartof breathing. Insert the ET tube such that the distal tip of the tuberate and rhythm, mucous membrane color, and pulse oximetrylies midway between the larynx and the thoracic inlet. Applyingprovide the best indexes of cardiovascular function.a light coating of sterile lubricating jelly improves the cuff ’s abilityto seal the airway against fluid migration.32Multiparameter electronic monitors are available and serve astools to assess physiologic parameters during the perianestheticInflate the cuff sufficiently to create a seal for adequate positiveperiod (Table 3). One must always evaluate the data the monitorpressure ventilation, being aware that overinflation may causeis conveying in light of all other parameters and make treatment33When changing the patient’s position afterdecisions based on the whole picture. Vigilant monitoring, in-intubation, take care to not rotate the ET tube within the trachea.terpretation, and responding to patient physiologic status by well-This might induce tracheal tears, especially if the cuff is rela-trained and attentive staff are critical.tracheal damage.tively overinflated. The American Veterinary Medical AssociationProvide thermal support and monitor body temperature(AVMA) Professional Liability Insurance Trust (PLIT) has indi-throughout the perianesthetic period. Supplemental heat may in-cated that tracheal tears are a significant issue in anesthetizedclude warm IV fluids, use of a fluid line warmer, insulation on thei 34However, tracheal intubation when properlypatient’s feet (e.g., bubble wrap), circulating warm-water blankets,performed and maintained is an essential part of maintaining anand/or warm air circulation systems. Do not use supplementalintubated cats .open and protected airway.Apply corneal lubricant postinduction to protect the eyesheat sources that are not designed specifically for anesthetizedpatients as they can cause severe thermal injury.36from corneal ulceration.Troubleshooting—Anesthetic ComplicationsMaintenance and MonitoringRecognize and then quickly and effectively respond to complicationsAnesthesia is typically maintained using inhalant anesthetics, al-as they develop. Anesthesia-related complications are responsible forthough maintenance can also be achieved with continuous infu-a significant number of AVMA PLIT insurance claimsj.sions or intermittent doses of injectable agents, or a combinationHypoventilation is an expected effect of general anesthesiaof injectable and inhalant drugs. An O2-enriched gas mixture isand can be estimated by observing respiratory rate and depth, butnecessary for the safe and effective administration of inhalantcan be quantified using capnometry. Observation of respiratoryanesthesia.23,29tidal volume is subjective, and it can be difficult to distinguish382JAAHA 47:6 Nov/Dec 2011
Veterinary Practice Guidelinesa normal from abnormal tidal volume. Normal end-tidal CO2 isperiodic auscultation are valuable in detecting life-threateningapproximately 35–40 mm Hg in awake patients and approxi-complications. Continue to monitor the electrocardiogram andmately 40–50 mm Hg in patients in a light surgical plane of an-blood pressure in those patients at significant risk of life-threateningesthesia. With increasing CO2, identify causes such as excessivehypotension or dysrhythmias.anesthetic depth, provide initial patient support by positive pressure ventilation, and adjust anesthetic management as indicated.Hypotension is a common complication during anesthesia.Respiratory depression persists during the early recovery fromanesthesia. Continue supplemental oxygen until SpO2 measurements are acceptable when breathing room air.Diagnose hypotension through blood pressure monitoring andExtubate when the patient can adequately protect its airwayevaluation of other physiologic parameters. Therapies for hypo-by vigorously swallowing. Deflate the cuff immediately beforetension include decreasing the depth of anesthesia, administeringremoving the ET tube. With patients that have undergone a dentalcrystalloid and/or colloid boluses, and/or administering vaso-procedure or oral surgery, it is beneficial to position the nosepressors and inotropes.slightly lower than the back of the head and leave the ET tube cuffMonitor for arrhythmias via auscultation, electrocardiog-slightly inflated during extubation. This will help clear blood clotsraphy, or by observing pulse–heart rate discongruity when usingand
general anesthesia, require appropriate monitoring and sup-portive care. They may require airway management and/or O 2 supplementation. Be prepared to intubate if necessary. · Experience and qualifications of personnel: Previous training in local and regional anesthesia
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still relevant nutrition-related guidelines produced by the American Animal Hospital Association. These include the 2010 AAHA Nutri-tional Assessment Guidelines for Dogs and Cats and the 2014 AAHA Weight Management Guidelines for Dogs and Cats .1,2 These prior guidelines address two essential components of nutritional manage-
the 2020 AAHA/AAFP Feline Vaccination Guidelines and resources through an educational grant to AAHA. † A. E. S. Stone was chair of the 2020 AAHA/AAFP Feline Vaccination Guidelines Task Force. These guidelines were prepared by a Task Force of experts convened by the American Ani
The robust advances in pain management for companion animals underlie the decision of AAHA and AAFP to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. The 2015 guidelines summarize and offer a discriminating review of much of this new knowledge. Pain management is central to veterinary
Animal Hospital Association (AAHA) accreditation standards and should not be considered minimum guidelines. Instead these guidelines are recommendations from an AAHA/American Asso-ciation of Feline Practitioners (AAFP) panel of experts. Therapy must be individualized and tailored to each patient andconstantlyre .
AAHA Members 15,131 Veterinarians 15,787 Veterinary assistants and support staff 6,722 Veterinary technicians 3,946 Practice managers 2,589 Other 44,175 TOTAL MEMBERS *Financial and Productivity Pulsepoints, Tenth Edition, AAHA Press, 2019. **As of July 1, 2020 2 Billion purchasing power* 4,511 AAHA-accredited and preaccredited .
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School of Public Health and College of Veterinary Medicine, University of Minnesota, Minneapolis, Minnesota). Correspondence: stull.82@osu.edu (J.S.) * These guidelines were prepared by a task force of experts convened by AAHA. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations .
