Anaesthesia for the geriatric dental patient - summary
This article summarises and combines "What should we consider when anaesthetising the geriatric patient" by Carl Brabrook and "What should we consider when anaesthetising patients, including geriatrics, for dental procedures?" into a single checklist on anaesthesia for the geriatric dental patient.
A downloadable checklist for "Anaesthesia for the geriatric dental patient" may be found here
PHYSIOLOGICAL AND ANATOMICAL CONSIDERATIONS
Reduced muscle mass
• Reduced IM injection sites & reduced maximum drug volumes/site
• Reduced protection for bony prominences
• Disrupted thermoregulation
Reduced body fat
• Increased risk of hypothermia (reduced insulation)
• Reduced protection for bony prominences
Reduced respiratory function
• Reduced lung elasticity, thoracic compliance & functional residual capacity
Reduced cardiac reserve
• Reduced cardiac output & vascular tone - reduced autoregulation and increased potential for hypotension
Altered hepatic & renal function
• Hypoproteinaemia and reduced drug binding
• Reduced metabolism & excretion of drugs – prolonged drug effects
• Reduced compensation for dehydration and haemorrhage.
Reduced CNS function
• Increased depressant effects of drugs, reduced MAC – potential for excessive anaesthetic depth & prolonged recoveries
• Depressed thermoregulation
• Potential problematic IV access & endotracheal intubation (TMJ OA)
• Exacerbation of joint pain from inappropriate positioning
Increased stress and anxiety
• Full history, signalment and clinical examination (including extent of dental disease & TMJ range of motion if possible)
• Blood analysis if dogs >7-8yo & cats >10yo
• If ASA III-V aim to stabilise prior to elective anaesthesia
• Focused approach based on the individual patient
• Reduce anaesthetic & procedure risk
• Based on health of the individual
• Reduced doses?
• Long duration may be further prolonged due to reduced hepatic metabolism
• Not antagonisable or analgesic
• Mild anti-emetic effect
• Analgesia and sedation
• Suitable if no contraindications
• Reduce dose
• Antagonisable (also antagonises analgesia)
• Full mu opioids preferable (can be “topped up”)
• Not recommended for healthy patients (disinhibition)
• Respiratory depression reported with diazepam
• IV preferable (reliable, maximal effect)
• IM may be painful (reduced muscle mass, comparatively large volumes, accidental periosteal trauma)
• Allow time to achieve peak effect (including IV)
• Monitor temperature following premedication & minimise heat loss
• 3-5 minutes via tight fitting facemask increases desaturation time
• Intravenously, slowly and to effect
• Avoid inhalation induction
• Alfaxalone has minimal cardiovascular and respiratory effects & is suitable for all ASA categories
• Mandatory for dental procedures
• SGADs not likely to create an adequate pharyngeal seal
• Pack pharynx & replace if saturated
• Careful patient repositioning to minimise pharyngeal/tracheal trauma
• Volatile maintenance is superior to TIVA
• Monitor carefully and adjust vaporiser based on observation
• Multimodal anaesthesia to minimise vaporiser settings & reduce incidence of hypotension & respiratory depression
• Locoregional (dental) nerve blocks
• Low dose ketamine
• Lidocaine infusions (dogs only)
• Dedicated, suitably trained personnel
• Electronic monitoring to allow early detection of abnormalities
• Regular temperature monitoring - increased risk of hypothermia (open mouth, irrigation fluids, evaporation etc)
- Balanced electrolytes e.g. Hartmanns unless otherwise indicated
- Begin at approximately 3ml/kg/hour for healthy cats
- Begin at approximately 4-5ml/kg/hour for healthy dogs
- Careful monitoring especially for lung/heart disease patients
• Remove all pharyngeal packing
• Check (& empty) bladder prior to recovery
• Continuous monitoring until extubated and can maintain sternal recumbency then:
• Regular until temperature >37oC and fully recovered
• Regular pain assessment and provision of analgesia
• Continue fluid therapy until fully recovered, eating and drinking
• Quiet environment
• Minimal stimulation
• Soft, comfortable bedding
• Considerate nursing (turning, urination, defaecation, human contact etc)
Originally published: Thursday, 15th August 2019
In this article Matt Gurney, RCVS/ECVS specialist in Veterinary Anaesthesia and Analgesia, examines whether co-induction techniques are advantageous.Read On...
What are the benefits of slow administration of alfaxalone and does co-induction with alfaxalone/midazolam have any benefits in healthy dogs?
In this summary of a study by Miller et al (2019) we examine if there are any benefits to an alfaxalone/midazolam induction over alfaxalone alone in the healthy dog.Read On...
In this article Carl Bradbrook discusses the peri-ananesthetic management of the canine gastric dilatation and volvulus (GDV) patient.Read On...
Paper summary: Clinical efficacy and cardiorespiratory effects of alfaxalone, or diazepam/fentanyl for induction of anaesthesia in dogs that are a poor anaesthetic risk.
In this summary of a paper by Psatha et al (2011) we examine the clinical benefits of alfaxalone in high-risk patients when compared to the induction protocol of diazepam + fentanyl.Read On...
In this article Miranda discusses the challenges of anaesthetising patients with cardiac disease and how protocols can be modified to accommodate these patients.Read On...
A prospective multi-centre clinical trial comparing buprenorphine vs butorphanol for postoperative analgesia in cats.Read On...
Paper summary: Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions.
With dental surgery one of the most commonly performed procedures in small animal practice, what benefits do dental nerve blocks provide in cats?Read On...
What should we consider when anaesthetising both adult and senior patients admitted for dental treatment?Read On...
In this article Ian Self, Associate Professor in Veterinary Anaesthesia and Analgesia, School of Veterinary Medicine and Science, Nottingham, reflects on the recognition, assessment and management options for chronic pain in companion animalsRead On...
With an increasing number of anaesthetics being performed in older pets is there anything we should be aware of or do differently? In this article Carl Bradbrook examines the management of anaesthesia in geriatrics..Read On...
Paper summary: What effect does does rapid, high volume fluid therapy have on cardiovascular function?
In this summary of a paper by Valverde (2012) we examine the effects of high-volume, rapid fluid therapy on cardiovascular function and hematological values during isoflurane-induced hypotension in healthy dogs.Read On...
In this summary of a paper by Joubert (2007) we examine the value of pre-anaesthetic screening in geriatric dogs and how the results influence the anaesthetic process.Read On...
Cushing's disease (hyperadrenocorticism) is relatively common in the dog and this article discusses the appropriate pre-anaesthetic assessment we should perform and why careful monitoring is essential.Read On...
Paper summary: How frequently are intravenous catheters removed as a result of complications due to bacterial contamination?
In this summary of a paper by Ramos (2018) we examine the incidence of bacterial colonisation of intravenous catheters removed as a result of cannula complicationRead On...
Peripheral venous cannulation is a common invasive procedure in small animals, but what are the best-practice insertion techniques and what can we do to avoid complications?Read On...
Paper summary: Heated intravenous fluids alone fail to prevent hypothermia in cats under general anaesthesia.
In this summary of a paper by Jourdan et al (2017) we examine the common practice of warming intravenous fluids and the effect on patient temperature.Read On...
This summary of a publication by Panti et al., examines the effect of orally administered omeprazole on gastro-oesophageal reflux in the anaesthetised dog.Read On...
In this paper we explore perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals.Read On...
How can a Veterinary version of the ASA Physical Status Classification help you achieve safer anaesthesia? To find out how watch our webinar.Read On...
This scientific paper assessed whether the American Society of Anesthesiologists (ASA) Physical Status Classification correlated with the risk of anaesthetic death in dogs and cats.Read On...
This is our third product launch this year, and the latest addition to our anaesthesia and analgesia portfolio, Methadyne, contains 10mg/ml methadone as its active ingredient. It can be administered for analgesia of moderate to severe pain in dogs and cats, to provide neuroleptanalgesia, and as part of a patient’s premedication protocol prior to general anaesthesia.Read On...
A retrospective comparison of two analgesic strategies after uncomplicated tibial plateau levelling osteotomy in dogs.
In this review we summarise a publication by Bini (2018) examining two protocols for the administration of methadone following TPLO surgery in dogs.Read On...
In this article we have identified the key clinical peer reviewed papers to support the use of Alfaxan for maintenance of Anaesthesia in Cats and Dogs.Read On...
Paper summary: Effect of benzodiazepines on the dose of alfaxalone needed for endotracheal intubation in healthy dogs
This paper examined whether a benzodiazepine, administered as a co-induction agent with alfaxalone, improved endotracheal intubation, and reduced the dose of alfaxalone, in the dogRead On...
In this article we examine why methadone could be considered the analgesic of choice for many of our patients and understand its importance in modern veterinary medicine. The article includes a link to a downloadable summary sheet.Read On...
In this article from the Perspectives on Premeds series, Karen takes us through the properties and uses of phenothiazines in modern veterinary practice.Read On...
This study looks at the effects of three methadone doses combined with acepromazine on sedation and some cardiopulmonary variables in dogs.Read On...
We have extended our anaesthesia and analgesia portfolio with the launch of AceSedate®. Containing the tried and trusted, long-acting sedative agent acepromazine as its active ingredient, AceSedate can be used for the premedication, sedation and tranquilisation of cats and dogs.Read On...
Caesarean Section Survival Guide. Part 2: Anaesthetic Protocol Selection & Peri-operative Considerations.
In this second instalment of the 2-part article, we explore premedication, induction, maintenance & monitoring, recovery and analgesia for the Caesarean section patient.Read On...
In the first instalment of this 2-part review Karen examines the physiological changes that occur during pregnancy and how those adjustments can affect the selection of anaesthetic protocols for the increasingly common Caesarean section.Read On...
No leeway for the spay: A comparison between methadone and buprenorphine for perioperative analgesia in dogs undergoing ovariohysterectomy.
This recent paper compares post-operative pain scores and requirement for rescue analgesia following premedication with methadone or buprenorphine, in combination with acepromazine or medetomidine, in 80 bitches undergoing ovariohysterectomy.Read On...
Cardiac arrest in dogs and cats is, thankfully, relatively rare. However, when it does happen it can have devastating consequences for the animal, owner and the veterinary team. This study examined the common causalities leading up to a cardiac arrest with the aim of changing protocols to improve outcomes.Read On...
In this article, Carl focuses on the benefits of introducing a safety checklist in practice to reduce patient morbidity, mortality and to improve communication between members of the veterinary team. The article contains links to the AVA safety checklist as well as a link to a customisable list that you can adapt to your practice needs.Read On...
The effects of hypothermia are very far reaching throughout the peri-anaesthetic process. In this article, James takes us through the interesting mechanisms of body cooling and warming, the clinical relevance of hypothermia and what we can do to prevent it.Read On...
All patients are exposed to the risks associated with general anaesthesia. Continuously monitoring anaesthetised patients maximises patients safety and wellbeing. In this article, Dan takes us through the common monitoring techniques that provide information about the cardiovascular status of your patient.Read On...
Despite being widely recognized in humans, postoperative nausea and vomiting (PONV), and the role of maropitant in reducing inhalational anaesthetic requirements have been poorly documented in dogs. This recent study evaluates PONV and isoflurane requirements after maropitant administration during routine ovariectomy in bitches.Read On...
Little information is available about the effect that different doses of medetomidine and butorphanol may have when using sevoflurane for maintenance of anaesthesia in dogs. This recent study evaluates heart rate and median sevoflurane concentration required at different dose rates.Read On...
In this second article of the capnography series, James provides a guide to a few of the most common traces that you will encounter during surgery. Scroll to the end of the article to download a printable capnography cheatsheet.Read On...
Pain, what a Pain! (Part 2) – Practical Tips On How To Perform Dental Nerve Blocks In Companion Animal Practice
In this second article of the Pain, what a Pain! series, Dan takes us through the LRA techniques associated with dental and oral surgery. In this article, you will find practical tips and pictures on common dental nerve blocks as well as safety concerns to consider.Read On...
This recent retrospective study looks at the cases of 185 pet rabbits admitted for sedation or general anaesthetic and evaluates the incidence and risk factors contributing to peri-anaesthetic mortality and gastrointestinal complications.Read On...
Pain, what a Pain! How Locoregional Anaesthesia can Improve the Outcome and Welfare of Veterinary Patients (Part 1)
In this first article out of a series of two, Dan takes us through an introduction and practical tips for appropriate local anaesthesia delivery. Find out why these anaesthesia techniques, that are well recognised in human medicine, have seen an increase in popularity in veterinary medicine over the recent yearsRead On...
Read the highlights of a recently published research paper that evaluates cardiorespiratory, sedative and antinociceptive effects of dexmedetomidine alone and in combination with morphine, methadone, meperidine, butorphanol, nalbuphine and tramadol.Read On...
This study evaluates the effectiveness of two methods of preoxygenation in healthy yet sedated dogs and the impact of these methods on time taken to reach a predetermined haemoglobin desaturation point (haemoglobin saturation (SpO2) of 90%) during an experimentally induced period of apnoea.Read On...