Cerenia is recommended before the procedure to prevent emesis, and it can be given either PO or IV 1-2 hours before the procedure.
Gabapentin can also be given orally before the procedure to help provide sedation to the patient and help facilitate the placement of the catheter.
<p> Preoperative Medications: <br>
Hydromorphone 0.1 mg/kg IV or IM. (You may give half the dose if given IV) <br>
Midazolam 0.2 mg/kg IV or IM. <br>
Occasional Ventricular Premature Complexes (VPC) are not uncommon in older patients and may be a result of underlying heart disease or from the administration of anesthetic drugs. If the patient is having multiple VPCs with a sustained heart rate of > 160 beats per minute than lidocaine ( 2 mg/kg IV) may be given. Typically, I do not treat occasional VPCs with intravenous lidocaine if the patient is maintaining a heart rate between 80-140 beats per minute while maintaining a mean blood pressure above 65 mmHg. <br>
If the patient becomes bradycardic (heart rate < 80 bpm), I will administer atropine 0.02 mg/kg IV or glycopyrrolate 0.01 mg/kg IV. I typically give half of the dose IV and then titrate to effect to prevent excessive tachycardia.
<p> Induction: <br>
Alfaxalone 6 mg/kg IV.
Please provide supplemental oxygen (100 %) via face mask for 5-10 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> Maintenance: <br>
Isoflurane: 1.3-1.8 % <br>
<p> Fluid Therapy: <br>
Isotonic crystalloid fluids – 5 mL/kg/hr during surgery <br>.
MONITORING: pulse oximetry, ECG, noninvasive blood pressure, end-tidal CO2 and temperature <br>
<p> Locoregional Techniques:<br>
Lidocaine or bupivacaine for dental blocks
<p> Postoperative Plan:<br>
NSAIDs are not recommended in the postoperative period since this patient is currently on prednisone. Dexamethasone SP 0.1 mg/kg IV may be given to alleviate inflammation in place of the NSAIDs. An additional dose of Buprenorphine (0.01 mg/kg IV) may be given after surgery for pain. <br>
<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/>