Given the elevated renal values (BUN, Cr), I recommend repeating the renal panel, rechecking her blood pressure and performing a urinalysis before the procedure day.
Gabapentin: 5-10 mg/kg PO. Given 2-3 hours before the procedure, gabapentin will provide sedation and help facilitate the placement of the catheter.
I recommend administering isotonic crystalloid fluids for 3-4 hours before anesthesia at 3-5 mL/kg/h.
Cerenia: 1 mg/kg IV
Midazolam: 0.2 mg/kg IV
Buprenorphine: 0.02 mg/kg IV
Hydromorphone: 0.05 mg/kg IV.
Propofol OR Alfaxalone: 4 mg/kg IV
Please provide supplemental oxygen (100 %) 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 to prevent hypoxemia if the patient becomes apneic.
Isoflurane: 1.3-1.8 %
Sevoflurane: 2.4-3.0 %
Isotonic crystalloid fluids – 5-10 mL/kg/h
MONITORING: pulse oximetry, ECG, noninvasive blood pressure, end-tidal CO2 and temperature
For intraoperative hypotension, I would consider a constant rate infusion of dopamine at 3-5 mcg/kg/min.
For intraoperative bradycardia (Heart Rate < 70 bpm), I would consider giving Atropine (0.01-0.02 mg/kg IV) OR Glycopyrrolate (0.005-0.01 mg/kg IV).
Dental Nerve Blocks:
Bupivicaine (0.5%): 0.1-0.2 mls per site
Buprenorphine: 0.01 mg/kg IV if needed
Given her elevated renal values, I would not administer or prescribe NSAIDs for this patient.
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.