Please discontinue amlodipine 24-48 hrs before the procedure to prevent potential hypotension during the dental procedure.
Administer 5-10 mg/kg gabapentin PO 2-3 hrs before the procedure to reduce stress during the catheter placement.
A balanced crystalloid fluid may be administered at 3 mls/kg/hr IV before the procedure.
For sedation and analgesia: Buprenorphine 0.02 mg/kg IV or hydromorphone 0.05 mg/kg IV.
Given that this is an older patient, if they are already calm or sedate I will give half of this opioid dose before induction and then the second half of the dose once the dental procedure starts. This prevents profound bradycardia which can happen with the administration of any opioid.
Induction: Propofol or alfaxalone 6 mg/kg IV
**Recommend face-masking the patient with 100% 02 for 5 minutes before induction.
Maintenance: Isoflurane 1-1.5% or sevoflurane 2-2.5% with 100% O2. Given the patient's size, a non-rebreather circuit is recommended to prevent dead space and hypercapnia.
Fluid Therapy: Balanced crystalloid solution – 3 mls/kg/hr
Local Anesthesia: Lidocaine or Bupivicaine 1 mg/kg total volume for dental blocks. Ideally, these blocks would be performed a minimum of 20 minutes before any tooth extractions.
Heat support via a pair hugger or water blanket is recommended. Please avoid heated water bottles as their misplacement may lead to thermal burns.
This patient may receive a NSAID. Meloxicam can be given at 0.1 mg/kg SC/IV.
Given that Yorkshire terriers are prone to tracheal collapse, which can be sub-clinical in presentation, I always calculate for a dose of acepromazine at 0.005-0.01 mg/kg IV. I will start with the low dose but have often given 0.01 mg/kg IV to older yorkie patients.
An additional dose of buprenorphine 0.01 mg/kg IV can be give post-operatively as well for additional analgesic support.
I recommend pulse oximetry in recovery for the first hour with TPRs every 30 minutes.