Pre-operative Plan:

Gabapentin 10 mg/kg PO
Cerenia 2 mg/kg PO

Please give the following drugs 2-3 hours before the procedure if possible. These medications will help with sedation for the catheter and prevent vomiting in the peri-operative period.
**Please give Acepromazine 0.02 mg/kg IM if the patient is uncooperative for the catheter. Although this patient is not exhibiting signs of a collapsing trachea, the swelling under the tongue may compromise the airway if the patient becomes stressed.

Given the elevated BUN and creatinine, I would place the patient on a balanced crystalloid at 5 mls/kg/hr before surgery. Ideally, the patient would receive 4-6 hours of fluid therapy before the procedure, and I would recheck a renal profile when the catheter is placed.

Analgesia: Buprenorphine 0.02 mg/kg IV or hydromorphone 0.05 mg/kg IV.

Induction: Propofol or alfaxalone 4 mg/kg IV
**Provide 100% O2 via facemark before induction for 5 minutes.

Maintenance: Isoflurane 1-2% or sevoflurane 2-3% with 100% O2 at 1 L/min.

Fluid Therapy: 5 mls/kg/hr with a balanced crystalloid for the entire peri-operative period.

Monitoring: SPO2, non-invasive blood pressure, ECG, capnography and temperature

Dental Locoregional Techniques: Lidocaine or bupivicaine: 1 mg/kg. Allow > 20 minutes for the blocks to take effect. I often perform them after the oral radiographs so they can take effect during the prophylactic cleaning.

Post-operative Plan: As mentioned, if the patient is dysphoric or stressed in the post-operative period, please give acepromazine 0.01 mg/kg IV. I typically dilute the dose in saline as it is a very small volume and give half the dose (0.005 mg/kg) IV first, then titrate to effect.

I recommend using a portable pulse oximeter in the recovery period for monitoring, given the patient's age and the oropharyngeal swelling. If the SPO2 drops below 95%, then flow-by O2 is recommended until the patient is able to maintain a SPO2 above 95%.

Pain Management: buprenorphine 0.01 mg/kg or hydromorphone 0.05 mg/kg IV can be given if needed. Given it's azotemia, I would be cautious prescribing a NSAID for post-operative pain management.