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Bernard D. Hansen DVM MS Diplomate DACVECC DACVIM 《Journal of Veterinary Emergency and Critical Care》2005,15(4):285-294
Objective: To summarize the challenges to recognizing pain in critically ill patients, the rationale for treatment even in the absence of signs of pain, and the therapeutic options available in the intensive care environment. Etiology: Pain is one of many stressors challenging the critically ill patient, and may in turn be multifactorial in nature. Common causes include local and systemic inflammation, injuries, diagnostic and therapeutic procedures, immobilization, and thrombosis. Diagnosis: Critically ill animals with pain may not demonstrate overt behavioral or physiologic signs of distress. Therefore, pain must be assumed to be present for animals whose condition puts them at risk. Therapy: Currently available analgesic and sedative drugs and methods of delivery are described. Several useful analgesics and sedatives may be co‐administered as fluid additives to provide continuous therapy. Prognosis: There is growing evidence that the neuroendocrine stress response to severe injury or illness may become sufficiently intense to contribute to morbidity and mortality. Many therapeutic analgesic and sedation options provide good control of pain and stress, and in some circumstances this may improve the outcome of critical illness. 相似文献
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Local anesthetics have the unique ability to produce complete blockade of sensory nerve fibers and prevent or pre-empt the development of secondary (central) sensitization to pain. For this reason, local and regional anesthetic techniques are often used with opioids, alpha 2-receptor agonists, dissociatives, and anti-inflammatory drugs as part of a multimodal strategy to manage pain. Lidocaine and bupivacaine are the local anesthetics used most commonly in dogs and cats. Lidocaine has a fast onset (10-15 min) and an intermediate duration of action (60-120 min), and is used for short diagnostic and surgical procedures. Bupivacaine has a slow onset (20-30 min) and a long duration of action (240-360 min), and is used to control pain both preoperatively and postoperatively. Local anesthetics are relatively safe if they are administered correctly. Administration of an excessive dose and accidental intravenous administration are probably the most common causes of systemic toxicity in small animals. Doses of local anesthetics, especially those for cats and small dogs, should always be calculated carefully. In many animals, the most simple and elegant way to control pain perioperatively is to perform a local or regional anesthetic block. Veterinarians should not hesitate to incorporate local and regional anesthetic techniques into their pain management strategies for dogs and cats. 相似文献
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Bednarski R Grimm K Harvey R Lukasik VM Penn WS Sargent B Spelts K;American Animal Hospital Association 《Journal of the American Animal Hospital Association》2011,47(6):377-385
Safe and effective anesthesia of dogs and cats rely on preanesthetic patient assessment and preparation. Patients should be premedicated with drugs that provide sedation and analgesia prior to anesthetic induction with drugs that allow endotracheal intubation. Maintenance is typically with a volatile anesthetic such as isoflurane or sevoflurane delivered via an endotracheal tube. In addition, local anesthetic nerve blocks; epidural administration of opioids; and constant rate infusions of lidocaine, ketamine, and opioids are useful to enhance analgesia. Cardiovascular, respiratory, and central nervous system functions are continuously monitored so that anesthetic depth can be modified as needed. Emergency drugs and equipment, as well as an action plan for their use, should be available throughout the perianesthetic period. Additionally, intravenous access and crystalloid or colloids are administered to maintain circulating blood volume. Someone trained in the detection of recovery abnormalities should monitor patients throughout recovery. Postoperatively attention is given to body temperature, level of sedation, and appropriate analgesia. 相似文献
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Sandra Wenger 《Journal of Exotic Pet Medicine》2012,21(1):7-16
Rabbits and rodents are popular pets and are often presented to veterinarians for evaluation and medical treatment. Anesthesia in exotic pets is required for many diagnostic and surgical procedures and is associated with a higher perioperative risk in rabbits and rodents when compared with dogs and cats. Inhalation anesthetic agents are commonly used as the sole source of anesthesia in small rodents, whereas injectable agents in combination with inhalation anesthesia are often used for rabbits and larger rodents. Analgesia is an important component of exotic pet medicine. Although it may be difficult to recognize signs of pain in companion exotic mammals, adequate pain management should always be provided. Opioid and nonsteroidal antiinflammatory drugs are the analgesic medications of choice, but others should be considered (e.g., local anesthetic agents). This article provides an update of the current literature regarding anesthesia and analgesia in rabbits and rodents. 相似文献
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Intra‐abdominal hypertension (IAH) may lead to a multiple organ dysfunction syndrome associated with significant dysfunction of the cardiovascular, respiratory, renal, gastrointestinal and central nervous systems of human patients. A recent prospective multicentre epidemiological investigation in man concluded that IAH was associated with an increased risk of mortality in critically ill patients. In this review, we present current information pertaining to the potential clinical importance of IAH in the context of equine clinical practice. In conclusion, consideration of intra‐abdominal pressure should be a part of the clinical assessment of patient well‐being in critically ill equine patients. 相似文献
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Woodward TM 《Topics in companion animal medicine》2008,23(2):106-114
Current standards of care in veterinary medicine dictate an adequate level of pain control for our patients. Effective pain control uses a proactive, multimode approach that starts with preoperative medications, includes the anesthetic protocol selected, and continues into the postoperative period. A basic understanding of the physiology of pain assists in selecting those agents and modalities best suited for individual patients. Analgesic drug selection and local anesthesia are both integral parts of pain control when performing surgery in the oral cavity. Local (regional) anesthesia plays an important part in the pain control of oral surgical patients. Regional anesthetic techniques are used for many common oral procedures, including extractions, periodontal flap surgery, treatment of traumatic injuries of the oral cavity, tumor removal, palatal surgery, periodontal therapy, and root canal therapy. This presentation will cover strategies for analgesia and the techniques and materials used in local/regional anesthesia in the oral cavity. Anatomic landmarks and guidelines for effective regional blocks will be covered. 相似文献
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Wright BD 《Clinical Techniques in Small Animal Practice》2002,17(4):151-157
Although pain management is an emerging and popular topic in veterinary medicine, use of analgesics in cats has received little attention relative to their canine counterparts. Some of the difficulty lies in assessment of whether or not a cat is in pain. Simple observation of a cat in a cage relies upon overt expression of pain, and is often inaccurate. Pain scales have been developed that allow a semiquantitative evaluation of the degree of pain an animal may be experiencing. However, treating pain based upon observation of the painful state is less effective than anticipating and preemptively treating pain. This article reviews specific methods for preemptively treating and alleviating pain in the cat. The traditional approach to pain management involves drug administration. Specific categories of agents used in cats include opioids, nonsteroidal anti-inflammatories, or alpha-2 agonists. Other modalities of pain management, which are also reviewed, include use of local anesthetic drugs for local and regional analgesia, as well as acupuncture. 相似文献
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Janyce Cornick-Seahorn 《Veterinary Clinics of North America: Equine Practice》2004,20(1):127-149
There is a plethora of information regarding anesthetic management of horses; however, controlled studies of the critically ill equine patient are few.These patients should be managed like any equine anesthetic candidate but much more stringently:I. Preoperative evaluation and appropriate therapy may represent the difference between life and death during the intraoperative and recovery periods. 2. The anesthetic induction and maintenance protocol should be based on the individual situation of the veterinary facility and personnel("comfort zone"). 3. Appropriate monitoring and intraoperative supportive measures are essential. 4. The anesthetic period is a significant perturbation to homeostasis. Even if the horse seems to have done well (ie, as indicated by the cardiopulmonary values), a problem-free anesthetic period does not guarantee a successful recovery, and close monitoring should continue until the horse is ambulatory. 5. Critically ill patients are often in a negative energy balance. Supportive measures to ensure an adequate caloric intake, such as enteral or parenteral nutrition, facilitate healing and return of homeostasis. 相似文献
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Several unique pharmacologic and physiologic factors must be considered when attempting to anesthetize premature or neonatal foals. Juvenile foals are similar to adults in their physiology and metabolism. Anesthetic drug and protocol selection should reflect the differences between these two age groups. Neonates are best anesthetized using an inhalation technique, whereas older foals can be safely anesthetized with either parenteral or inhalation anesthetic agents. Careful monitoring is absolutely essential when anesthetizing foals. The clinician should plan to routinely administer fluids and measure electrolyte levels. A basic plan and knowledge of the methods and agents used to treat hypovolemia, severe cardiopulmonary collapse, and life-threatening arrhythmias can result in survival of many critically ill foals. 相似文献
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Dohoo SE 《The Canadian veterinary journal. La revue veterinaire canadienne》1990,31(12):847-850
Isoflurane is the most recently available inhalational anesthetic agent on the market today. Although there have been few clinical trials comparing its use to halothane and methoxyflurane, the pharmacology of the agent suggests certain situations in which it may be the preferable agent. These include avian anesthesia, geriatric patients, patients with cardiovascular disease or hepatic disease, critically ill and unstable patients, cases such as brachiocephalics where upper airway obstruction is a concern during recovery, patients where increases in intracranial pressure should be avoided, and cesarean section. In addition, the rapid recoveries seen with isoflurane may be an advantage for outpatient surgeries. 相似文献
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Angela K. O'Hearn DVM Bonnie D. Wright DVM DACVA 《Journal of Veterinary Emergency and Critical Care》2011,21(1):50-52
Objective – To describe the technique for performing a coccygeal epidural injection of local anesthetic to facilitate catheterization in male cats with urethral obstructions using low‐dose sedation. Significance – Prompt diagnosis and relief of urethral obstructions is important as many cats may have developed marked metabolic abnormalities at the time of presentation. General anesthesia in these patients may be associated with significant risk for complications. Pain management is also an essential treatment goal, and this technique relieves urethral and penile pain during the unblocking process. Conclusion – Coccygeal epidurals can be used safely to provide analgesia to the penis and urethra and to the authors' knowledge, is a novel treatment modality to aid in the relief of urethral obstructions in male cats. 相似文献
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COLIN F. BURROWS † 《The Journal of small animal practice》1981,22(5):231-252
The term ‘intensive care’ is becoming increasingly popular in veterinary medicine to describe those techniques employed in caring for the critically ill animal. Application of the techniques required for intensive care is not difficult and can be employed in any veterinary practice. The purpose of intensive care is the uncomplicated conversion of a dramatic disease process into an uneventful one, not the performance of life-saving heroics. Critically ill patients share several common features, particularly the need for diligent monitoring and nursing. Regardless of the primary disease, the function of many organs is frequently impaired in these patients and they require total body care. Critically ill animals may have fluid, acid-base and electrolyte imbalances, increased caloric requirements and an increased susceptibility to infection. This paper describes the equipping and staffing of an intensive care unit and the various techniques for monitoring critically ill animals. It also reviews aspects of fluid and electrolyte disturbances and therapy, and the unusual respiratory problems and nutritional requirements of these patients. 相似文献
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Pet rabbits frequently become stressed when handled and may require sedation or chemical immobilization for procedures such as blood collection, IV catheter placement, radiography, deep ear cleaning, and dentistry. Common surgical procedures requiring general anesthesia include spay, castration, gastrotomy, cystotomy, and orthopedic procedures. Rabbits may be difficult to safely sedate or anesthetize. Individual rabbits may have varying sensitivity to the depressant effects of anesthetics. The apparent sensitivity of the rabbit's respiratory center to anesthetic drugs and the narrow range between anesthetic and toxic doses in this species add to the unpredictable character of rabbit anesthesia. Furthermore, mortality following anesthesia and surgery in sick rabbits is common. Strategically, safe anesthesia of rabbits must include the planning of procedures so that anesthetic time is minimized. Clinicians must be on guard for individual variation in response to drugs. Minimizing the use of cardiovascular depressant agents, use of agents with a high therapeutic index, and careful titration of doses to effect, along with thorough cardiorespiratory monitoring, will permit attainment of appropriate anesthetic depth with the widest margin of safety. This article presents several injectable and inhalant anesthetic protocols that may assist in effective management of many types of rabbit patient. 相似文献
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R R Paddleford 《Veterinary Clinics of North America: Small Animal Practice》1992,22(2):481-484
At the time of cesarean section, the mother may suffer respiratory depression, hypotension, increased gastric acidity, and increased predisposition to regurgitation, and the newborn may suffer anesthetic-induced respiratory depression. Preanesthetic metaclopramide, cimetidine, and anticholinergic agent are recommended. Sedatives can be administered if necessary. Neuroleptanalgesic and low-dose general anesthetic, with local anesthetic line-blocks, are preferred techniques. Supportive care of the newborn is mandatory. 相似文献
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James S. Wohl DVM Diplomate ACVECC ACVIM Terrence P. Clark DVM Ph.D. Diplomate ACVCP 《Journal of Veterinary Emergency and Critical Care》2000,10(1):21-34
Vasopressors are agents that increase systemic vascular resistance by increasing vasoconstriction. Therapy with intravenous vasopressors may be required in critically ill patients when efforts to optimize cardiac output and blood pressure with intravascular fluid therapy fail. Increasing systemic vascular resistance can promote a favorable perfusion pressure gradient to vital organs in critically ill patients with severe, unresponsive vasodilation. Improperly administered, vasopressors may impede cardiac output and reduce oxygen transport to vital tissue sites. The understanding of systemic and regional effects of vasopressors is currently evolving. Recent literature of the commonly used agents is reviewed. Individual drugs, drug combinations, and potential new therapies are discussed. (Vet. Emerg. & Crit. Care, 10:19–33, 2000) 相似文献
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Hewitt SA Brisson BA Sinclair MD Sears WC 《American journal of veterinary research》2007,68(4):358-369
OBJECTIVE: To evaluate the use of laparoscopic-assisted jejunostomy feeding tube (J-tube) placement in healthy dogs under sedation with epidural and local anesthesia and compare cardiopulmonary responses during this epidural anesthetic protocol with cardiopulmonary responses during general anesthesia for laparoscopic-assisted or open surgical J-tube placement. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly assigned to receive open surgical J-tube placement under general anesthesia (n = 5 dogs; group 1), laparoscopic-assisted J-tube placement under general anesthesia (5; group 2), or laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia (5; group 3). Cardiopulmonary responses were measured at baseline (time 0), every 5 minutes during the procedure (times 5 to 30 minutes), and after the procedure (after desufflation [groups 2 and 3] or at the start of abdominal closure [group 1]). Stroke volume, cardiac index, and O(2) delivery were calculated. RESULTS: All group 3 dogs tolerated laparoscopic-assisted J-tube placement under sedation with epidural and local anesthesia. Comparison of cardiovascular parameters revealed a significantly higher cardiac index, mean arterial pressure, and O(2) delivery in group 3 dogs, compared with group 1 and 2 dogs. Minimal differences in hemodynamic parameters were found between groups undergoing laparoscopic-assisted and open surgical J-tube placement under general anesthesia (ie, groups 1 and 2); these differences were not considered to be clinically important in healthy research dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Sedation with epidural and local anesthesia provided satisfactory conditions for laparoscopic-assisted J-tube placement in healthy dogs; this anesthetic protocol caused less cardiopulmonary depression than general anesthesia and may represent a better choice for J-tube placement in critically ill patients. 相似文献
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Establishing and maintaining vascular access is often vital to the preoperative, intraoperative, and postoperative management of the small animal emergency surgical patient. Vascular access may be used for the delivery of crystalloids, colloids, blood components, medications, and anesthetic or sedative agents. It can also facilitate venous and arterial blood sampling and allow direct measurement of arterial and venous pressures. The small animal emergency and critical care veterinarian should have a thorough knowledge of vascular access techniques, including peripheral and central venous catheterization, intraosseous, and arterial access. Competence in percutaneous, percutaneous facilitative, and surgical cutdown approaches should ensure that vascular access can always be established in the critically ill patient. 相似文献
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Vicki L Campbell 《Veterinary Clinics of North America: Small Animal Practice》2005,35(2):435-453
Anesthesia, sedation, and pain management should be taken seriously in the emergency patient. Proper knowledge of the drugs available and their pharmacokinetics and pharmacodynamics are necessary to administer anesthesia safely to critical patients. A proactive approach regarding monitoring, titration of anesthetic drugs, and anticipation of life-threatening complications helps in achieving successful anesthetic outcomes. 相似文献