<p>
<br> <br>
An elevation in alkaline phosphatase (Alk Phos) can be a result from a variety of factors including liver disease. Given that her alanine transaminase (ALT) is within normal limits, we can safely administer anesthetic agents to these patients as their liver function and metabolism should still be adequate. This being said, she is a geriatric patient thus I typically use judicious doses to remain on the safe side as she may have underlying heart disease even though no murmur was auscultated.
</p>
<p> PREOPERATIVE MEDICATIONS: <br>
Gabapentin: Give 10 mg/kg PO 2-3 hours before the procedure to help facilitate the placement of the catheter.

<br>

Cerenia: Give 1 mg/kg IV diluted 1:3 with 0.9 % saline to prevent irritation of the vein upon injection.

<br>

Buprenorphine: Give 0.02 mg/kg IV <br>

OR <br>

Hydromorphone: Give 0.05 mg/kg IV. With Hydromorphone, I typically give the dose slowly IV (3-5 minutes) to prevent excitation. <br>

If she becomes bradycardic (Heart Rate < 80 bpm) after the induction as a result of the opioid, I will administer Atropine (0.01-0.02 mg/kg IV) or Glycopyrrolate (0.005 mg/kg IV).
</p>
<p> INDUCTION: <br>
Propofol or Alfaxalone 4-6 mg/kg IV
<br>

Please provide supplemental oxygen via face mask for 5 minutes before induction. It is important that the face mask remains on the patient’s face through the induction period so that if they do become apneic from the induction drug, they will have 100% O2 at the level of the alveoli to prevent hypoxemia while you intubate.

</p>
<p> MAINTENANCE: <br>
Isoflurane 1-2%

</p>
<p> FLUID THERAPY: <br>
Balanced crystalloid – 3 mls/kg/hr

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

</p>
<p> LOCOREGIONAL TECHNIQUES:<br>
Dental blocks with Lidocaine or Bupivicaine, 1 mg/kg total dose. A local block can also be performed either before or after the removal of the perianal mass. If you suspect the mass is malignant then I would recommend doing a splash block after the mass is removed. You can use 0.5 mg/kg of either Lidocaine or Bupivicaine for this block.

</p>
<p> POSTOPERATIVE PLAN:<br>
If the pet is painful after the procedure, she may receive another dose of Buprenorphine at 0.01 mg/kg IV. If she is dysphoric, please give Acepromazine 0.005-0.01 mg/kg IV. I typically start with the lower dose of Acepromazine to prevent a longer recovery time. <br>
Carprofen 2.2 mg/kg SC or Meloxicam 0.1 mg/kg SC can be administered for pain in this patient since her ALT value is within normal limits.

<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/>