Given the elevations in both BUN and SDMA values, I recommend fluid therapy before the procedure if possible. <br>
I would also adjust drug doses based on a lean body weight.

</p>
<p> Preoperative Medications: <br>
Cerenia 1 mg/kg IV
Buprenorphine 0.02 mg/kg IV

</p>
<p> Induction: <br>
Alfaxalone or 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. <br>
I am less concerned about the thoracic soft tissue opacities given that the patient doesn’t have a history of tachypnea or cyanosis. I would limit any intermittent positive pressure breaths during anesthesia to 10 cm H2O of inspiratory pressure.

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

</p>
<p> Fluid Therapy: <br>
Isotonic crystalloid fluids – 10 mL/kg/hr during surgery <br>.

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

</p>
<p> Locoregional Techniques:<br>
Lidocaine or bupivacaine for dental blocks
</p>
<p> Postoperative Plan:<br>
I would consider a short course of NSAIDs (Onsior) post-procedure. This drug is typically well tolerated by cats with elevated renal values. An additional dose of Buprenorphine (0.01 mg/kg IV) may be given after surgery for pain. <br>
<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/>
<p>
7/1/2022