This patient may benefit from preoperative fluid therapy given the elevated SDMA value. <br> The pimobendan should be administered the morning of the surgery. <br> Gabapentin (5 mg/kg PO), trazadone (3 mg/kg PO) and cerenia (2 mg/kg PO) can be given the morning of surgery for sedation and to prevent nausea.

<p> Preoperative Medications: <br>
Midazolam or diazepam: 0.2 mg/kg IV <br>
Hydromorphone: 0.1 mg/kg IV. <br>
If Rosita becomes bradycardic from the hydromorphone, she can receive a dose of either Atropine (0.02 mg/kg IV) or Glycopyrrolate (0.005 mg/kg IV).

<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>

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

<p> Fluid Therapy: <br>
Isotonic crystalloid fluids – 5 mL/kg/hr during surgery <br>. A 5 mL/kg fluid bolus may be considered if Rosita becomes hypotensive during surgery, and this bolus may be repeated if necessary.

<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>
Rimadyl or meloxicam can be administered after the surgery. I would consider a 5-day course of oral NSAIDs after surgery. <br>

A 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/>