Cerenia may be given orally the morning of the procedure or IV once the catheter is placed. This drug does not prevent regurgitation since it’s mechanism of action is to prevent emesis, exclusively.<br>
Given the history of postoperative dysphoria with dexmedetomidine and butorphanol, I would use an opioid/propofol combination with a local block. <br> I would base the dosing on a lean body weight given that Bruiser weighs 87lbs.
<p> Preoperative Medications: <br>
Buprenorphine 0.02 mcg/kg IV <br> OR<br>
Hydromorphone 0.05 mg/kg IV <br>
Metoclopramide 0.5 mg/kg IV

<p> Induction: <br>
Propofol 6 mg/kg IV.

Please provide supplemental oxygen (100 %) via face mask for 5-10 minutes before induction. It is important that the face mask remains on the patient’s face through the induction period to prevent hypoxemia if the patient becomes apneic.

<p> Maintenance: <br>
Isoflurane: 1.3-1.8 % <br>

<p> Fluid Therapy: <br>
Isotonic crystalloid fluids – 5 mL/kg/hr during surgery <br>.

<p>Intraoperative Monitoring:<br>
MONITORING: pulse oximetry, ECG, noninvasive blood pressure, end-tidal CO2 and temperature <br>

<p> Locoregional Techniques:<br>
Lidocaine or bupivacaine for dental blocks
<p> Postoperative Plan:<br>
NSAIDs or an additional dose of Buprenorphine (0.01 mg/kg IV) may be given after surgery for pain. <br> If Bruiser has a delayed recovery, consider giving Naloxone 0.02 mg/kg IM.
<br><br>Please continue to monitor the patient with pulse oximetry in the postoperative period for 30 minutes. If her SPO2 reading falls below 95%, please provide supplemental oxygen via face mask. <p/>