Feline Anesthesia and Pain Management

The editorsPaulo Steagall, MV, MS, PhD, DACVAA, is an associate professor of veterinary anesthesia and analgesia at the Université de Montréal in Montreal, Quebec, Canada. Sheilah Robertson, BVMS (Hons), PhD, DACVAA, DECVAA, CVA, DACAW, Dip ECAWBM, is the chief medical officer for Lap of Love Inc, a large network of veterinarians offering home-based hospice and euthanasia. Polly Taylor, MA, VetMB, PhD, DVA, DipECVAA, MRCA, FRCVS, is a European and Royal College of Veterinary Surgeons specialist in veterinary anesthesia working as an independent consultant in veterinary anesthesia.

• Foreword xviiContributors xix1 Handling, Restraint, and Preanesthetic Assessment 1Graeme Doodnaught and Paulo SteagallIntroduction 1Handling and Restraint 2Preanesthetic Assessment 10Risk Factors, Morbidity, and Mortality 12Further Reading 142 Anatomy, Physiology, and Pharmacology 17Bradley Simon and Paulo SteagallIntroduction 17Cardiovascular System 17Respiratory System 22Nervous System 25Urinary System 27Hepatic System 30Endocrine System 31Gastrointestinal System 32Further Reading 333 Sedation and Premedication 35Paulo SteagallIntroduction 35Drugs used for Sedation in Cats 36Acepromazine 36Benzodiazepines 39Agonists of α 2 -Adrenergic Receptors 40Anticholinergics 43Opioids 44Ketamine and Alfaxalone 45Trazodone 45Other Drugs 45Further Reading 464 Injectable Anesthetics and Induction of Anesthesia 49Paulo SteagallIntroduction 49General Considerations for Induction of Anesthesia 50Drugs used for Induction of Anesthesia 51Propofol 51Alfaxalone 54Dissociative Anesthetics (Ketamine and Tiletamine) 55Barbiturates 57Etomidate 59Fentanyl plus Midazolam 60Induction with Volatile Anesthetics 60Total Intravenous Anesthesia (TIVA) 61Infusion Devices 62Injectable-only Protocols 62Further Reading 645 Local Anesthetics and Loco-regional Techniques 67Francesco Staffieri and Paulo SteagallIntroduction 67Physicochemical and Pharmacodynamic Properties of Local Anesthetics 68Axons and Nerve Fibers 69Pharmacokinetics 70Factors Influencing Onset and Duration of Action 70Metabolism 71Adjuvants 71Local Anesthetics 71Adverse Effects 74Techniques for Nerve Location 77Local Anesthetic Techniques 78Further Reading 856 Inhalation and Balanced Anesthesia 89Bruno PypendopVolatile Anesthetics 89Halothane 90Isoflurane 90Sevoflurane 91Desflurane 91Balanced Anesthetic Techniques 92Opioids 93Ketamine 95Nitrous Oxide 96Lidocaine 97Dexmedetomidine 98Gabapentin 98Balanced Anesthesia Summary 99Breathing Systems 99Further Reading 1037 Monitoring 105Daniel PangIntroduction 105Clinical Monitoring using Physical Senses (“Hands On”) 106Cardiovascular System 107Respiratory System 112Further Reading 1218 Fluid Therapy 123Peter PascoeIntroduction 123Feline Physiology and Pathology with regard to Fluid Therapy 123Fluids 125Preoperative Preparation 129Intraoperative Fluids 132Postoperative Care 136Further Reading 1379 Anesthetic Management of Special Conditions 139Paulo SteagallIntroduction 139Urethral Obstruction and Uroabdomen 139Chronic Kidney Disease (CKD) 143Hyperthyroidism 145Hypertrophic Cardiomyopathy (HCM) 147Neuroanesthesia 148Diaphragmatic Rupture 151Gastrointestinal Emergencies 153Idiopathic Hepatic Lipidosis 154Diabetes Mellitus 155Other Conditions 156Further Reading 15710 Anesthetic Complications 159Polly Taylor and Sheilah RobertsonIntroduction 159Airway Management 161Respiratory Insufficiency 167Circulation 169Trauma 173Recovery 174Body Temperature 176Cardiopulmonary Resuscitation (CPR) 177Further Reading 18011 Mechanisms of Pain 183Craig B. JohnsonIntroduction 183Mechanisms of Modulation in Tissues 183Mechanisms of Modulation in Peripheral Nerves 186Mechanisms of Modulation in The Spinal Cord 188Mechanisms of Modulation in the Brain 189The Role of Glial Cells (Glia, Neuroglia) and the Immune System 191Mechanisms of Cancer Pain 192Diabetic Neuropathy 195Pruritus (Itch) 196Further Reading 19712 Assessment and Recognition of Acute Pain 199Sheilah RobertsonIntroduction 199Pain-assessment Tools 199Behavior-based Indicators of Pain 206Intervention Scores 212Using Response to Treatment as a Diagnostic Tool 212Confounding Factors 212Personality, Fear and Stress 213Using Pain-assessment Tools 216Continued Assessment at Home 216Further Reading 21713 Treatment of Acute (Adaptive) Pain 221Paulo Steagall and Polly TaylorIntroduction 221Challenges in Feline Pain Management 222Principles of Pain Management 223Nonpharmacological Therapies in Acute Pain Management 227Pharmacological Therapy in Acute Pain Management 229Further Reading 23714 Assessment and Recognition of Chronic (Maladaptive) Pain 241Beatriz Monteiro and Duncan LascellesIntroduction 241Common Causes of Chronic Pain 244Clinical Signs 244Implications for Quality of Life 246The Concept of Analgesic Challenge 248Assessing Chronic Pain in Specific Conditions 248Further Reading 25515 Treatment of Chronic (Maladaptive) Pain 257Beatriz Monteiro and Eric TroncyIntroduction 257Client Communication: A Crucial Component of Treatment for Chronic Painful Conditions 258Challenges in the Treatment of Chronic Pain in Cats 258Pharmacological Therapy 261Opioids 261Local Anesthetics 261Nonsteroidal Anti-inflammatory Drugs (NSAIDs) 263Tramadol 267Gabapentin 268Amantadine 270Emerging Analgesic Modalities 270Other Analgesics 271Nonpharmacological Treatment 272Physical Activity and Weight Control 272Physical Therapy, Massage, Acupuncture, and Transcutaneous Electrical Nerve Stimulation (TENS) 273Monitoring for Treatment Efficacy 276Degenerative Joint Disease (DJD) 276Further Reading 278Index 281