<p>
<br> <br>
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.
</p>
<p> PREOPERATIVE MEDICATIONS: <br>
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.

<br>
I recommend administering isotonic crystalloid fluids for 3-4 hours before anesthesia at 3-5 mL/kg/h.
<br>
Cerenia: 1 mg/kg IV

<br>

Midazolam: 0.2 mg/kg IV <br>

Buprenorphine: 0.02 mg/kg IV <br>

OR <br>

Hydromorphone: 0.05 mg/kg IV. <br>

</p>
<p> INDUCTION: <br>
Propofol OR Alfaxalone: 4 mg/kg IV
<br>

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.

</p>
<p> MAINTENANCE: <br>
Isoflurane: 1.3-1.8 % <br>
Sevoflurane: 2.4-3.0 % <br>

</p>
<p> FLUID THERAPY: <br>
Isotonic crystalloid fluids – 5-10 mL/kg/h

</p>
<p>INTRAOPERATIVE MONITORING:<br>
MONITORING: pulse oximetry, ECG, noninvasive blood pressure, end-tidal CO2 and temperature <br>
For intraoperative hypotension, I would consider a constant rate infusion of dopamine at 3-5 mcg/kg/min. <br>
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).

</p>
<p> Dental Nerve Blocks:<br>
Bupivicaine (0.5%): 0.1-0.2 mls per site
</p>
<p> POSTOPERATIVE PLAN:<br>
Buprenorphine: 0.01 mg/kg IV if needed
Given her elevated renal values, I would not administer or prescribe NSAIDs for this patient.
<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/>