Safe Feline Sedation

and Anesthesia

Katy W. Waddell, LVT, VTS

(ECC) (Anesthesia/Analgesia)
 Normal Behavior
• Many clients do not understand that cats are
genetically programmed to hide signs of illness and
injury

• Cats are unique as the only companion animals that

are solitary hunters, as well as being both predators
and prey.
Common stressors for cats in
veterinary hospitals
• Other animals and humans

• Noise (eg, medical equipment, telephones, barking,

human conversation)

• Smells and odors (eg, other animals, disinfectants)

ASA Status Class I

• Minimal Risk

• Normal healthy animal, no underlying disease

Class II
• Slight risk, minor disease present

• Animal with slight to mild systemic disturbance,

animal able to compensate

• Neonate or geriatric animals, obese

Class III
• Moderate risk, obvious disease present

• Animal with moderate systemic disease or

disturbances, mild clinical signs

• Anemia, moderate dehydration, fever, low-grade

heart murmur or cardiac disease
Class IV
• High risk, significantly compromised by disease

• Animals with preexisting systemic disease or

disturbances or a severe nature

• Severe dehydration, shock, uremia, or toxemia, high

fever, uncompensated heart disease,
uncompensated diabetes, pulmonary disease,
emaciation
Class V
• Extreme risk, moribund

• Surgery often performed in desperation on animal

with life threatening systemic disease

• Advance cases of heart, kidney, liver or endocrine

disease, profound shock, sever trauma, pulmonary
embolus, terminal malignancy
ASA Status
• One feline study that evaluated age and ASA physical
status as risk factors for perianesthetic morbidity and
mortality found that ASA status rather than age was
a better predictor of perianesthetic complications.

• Cats with an ASA status of 3 or higher had a

significantly increased risk of complications.

• Another study found that age (>12 years) was a risk

factor independent of ASA status.
Neonates
• The neonate's physiologic differences from the adult

• The cardiac output is rate dependant in the neonate. The

resting output is very near the maximum potential output.
Cardiac reserve is minimal.

• High metabolic rate leads to high oxygen consumption.

• Neonates poorly regulate their body temperature.

• The blood-brain barrier is more highly permeable.

• Neonates have low protein binding of drugs due to
reduced albumin.

• High body water content, low body fat. Extracellular

fluid volume higher than adult.

• Decreased renal function, reduced renal clearance

• Immature hepatic enzyme function leads to reduced

hepatic clearance.
0-6 months
• minimal glycogen stores in the liver of the pediatric
patient,
• withholding of food should be kept to a minimum.
• Unweaned puppies and kittens should not be fasted,
• patients older than 6 weeks of age fast only for a
maximum of 3 to 4 hours before general anesthesia.
• Prolonged fasting of these patients may result in
hypoglycemia and dehydration and predispose them
to hypothermia.
• Withholding of water is unnecessary.
Junior 6 months to 2 years
• Teenagers to young adult equivalent

• Minimum data base vs Big 4

Prime 3-6 years
• 28 – 40 human equivalent

• Prime for data base?

• Always ascertain BCS and MCS

Mature 7 – 10 years
• 44 – 56 human equivalent

• Data base include thyroid panel?

• Always ascertain BCS and MCS

Senior 11 – 14 years
• 60 – 72 human equivalent

• Thyroid ?

• Activity level

• Always ascertain BCS and MCS

Geriatric 15 + years
• 76 + human equivalent years
Develop a plan
• Working with the owner

• Less hectic schedule

• Meds to be given at home

Patient physical examination

• signalment, physiologic parameters and all body

systems

• BCS, MCS

• identify any potential trends

Fearful patients
• Can you identify fearful cats prior to visit?

• Yes – consider gabapentin to be given at home

• No – always use feline friendly handling methods

• Especially with unknown health status
• On admission

• Move to quiet exam room

• IF amenable – physical exam with FF handling

• IF unsafe to patient/staff – consider chemical

restraint
• Have all supplies ready at hand!

• Be flexible, each patient is an individual

• Remain calm

• Synthetic pheromones
• The increased release of catecholamines in fearful or
stressed cats leads to

• tachycardia,

• systemic hypertension

• and/or tachypnea,

• all of which can increase the risks associated with

anesthesia
Physiological Effects of Stress
• Hyperglycemia
• Hypokalemia
• Increased CPK
• Lymphopenia
• Neutrophilia
• Hypertension
• Cardiac murmurs
• Improper response to drugs
Gabapentin
• Gabapentin (50 – 100 mg per cat or 150 mg if big cat,
PO, 2 – 3 hours before arrival)

• May be given twice, evening before appointment and

morning of appointment

• Geriatric or senior cats may try lower dose (50mg)

• Does have some analgesic effects

Alfaxalone IM
• 1-2 mg/kg

• Better results with addition of midazolam or

butorphanol

• Usually manageable within 7-10 minutes

• Short duration
Kitty magic
• Gazillion recipes !!!!!
• TBD

• Premed or mild to moderate sedation:

• Telazol@ 1mg/kg
• Butorphanol@0.05 mg/kg
• Dexmedetomidine @ 2.5 mcg/kg
• TBD
• Profound ! Sedation
• Telazol @ 2 mg/kg
• Butorphanol @ 0.1 mg/kg
• Dexmedetomedine @ 5 mcg/kg
My usual combination if necessary
• Dexmedetomedine @ 2mcg/kg
• Butorphanol @ 0.3 mg/kg
• Ketamine @ 4 mg/kg
For geriatric or ill cats
• Butorphanol (0.2 – 0.4 mg/kg, IM) or Methadone
(0.3 – 0.5 mg/kg, IM) +
• Alfaxan (1 – 2 mg/kg, IM)

• Butorphanol (0.2 – 0.4 mg/kg, IM) +/- Midazolam

(0.2 mg/kg, IM)
Box or mask inductions
• hazardous approach to “sedating” the fearful feline.
• should be avoided

• 1) scary and stressful for patients,

• 2) dangerous to personnel (exposure to inhalants

associated with numerous adverse health effects
including impaired reproductive function), and

• 3) dangerous to the patient

Kitty would prefer some chemicals
I’m a good boy
Purpose of premedication

• Prevention of:
– Increase of sympathetic tone caused by:
• Fright
• Excitation
• Difficult restraint

Which lead to:

• Increased metabolism
• Increased cardiac work/oxygen demand
• Predisposition to arrhythmias
• All of which may lead to hypoxia
Premedication options
• Drug dosages used for premedication should be
tailored to the individual cat.

• opioids are useful for premedication and as part of

procedural sedation
• Morphine and buprenorphine undergo hepatic
metabolism with glucuronidation, so the duration of
action of these tends to be longer because of the
lack of functional glucuronyl transferase in cats.
• At the low doses of opioids generally used for
premedication, the heart rate may decrease slightly.

• Anticholinergics can be used to reverse this effect if

deemed necessary.

• Atropine (0.02 mg/kg) and glycopyrrolate (0.01

mg/kg) SC may increase heart rate by about 10% in
combination with an opioid
 Benzodiazepines

 Midazolam and diazepam:

 Cause little or no myocardial depressant effects

 May see increase in heart rate due to excitation

with inadequate use of adjunctive agent
i.e. mu opioid
• Buprenorphine – mixed agonist/antagonist
• Duration of action 4-6 hours, good for mild to
moderate pain

• 0.01 - 0.02 mg /kg IM or IV

• Butorphanol – mixed agonist/antagonist
• 0.1 -0.4 mg/kg IM or IV
• Duration 60 – 90 minutes
• Better sedation in cats than dogs
• Mild – moderate pain
 Alpha 2 agonists
• Used in veterinary medicine to produce:

• sedation,

• analgesia

• Anxiolysis

• Reduce requirements of anesthetics

 Fentanyl
• Pure mu agonsist

• Causes dose dependant bradycardia (increase in

vagal tone)

• Bradycardia is responsive to anticholinergics –

atropine/glycopyrrolate

• Single dose IV is very short acting – up to 20

minute duration
 Hydromorphone:
• morphine-like agonist, primary activity at the mu
receptors.
• bradycardia due to central vagal stimulation,
• alpha-adrenergic depression causing peripheral
vasodilaiton, decreased peripheral resistance
• baroreceptor inhibition.
• 0.02 -0.1 mg/kg
• Moderate duration 2-4 hours
Oxymorphone

• Similar effects to hydromorphone

• Case management of side effects the same

• 0.02 – 0.1 mg/kg

• 2 – 4 hour duration
Methadone
• Increase in vagal tone – dose dependent

• 0.2 – 0.5 mg/kg

• 2 – 4 hour duration
Alpha 2 adrenergic agonists

• Cardiovascular effects include vasoconstriction,

decreased heart rate (by 40%) and cardiac output (by
60%) and increased systemic vascular resistance
(300%) with minimal change in blood pressure.

• If α -adrenergic agonists are used for premedication,

the decreased cardiac output may slow the onset of
subsequent intravenous induction drugs.
 Dexmedetomidine

• Alpha 2 agonist

– 0.00025 – 0.04 mg/kg

higher doses may induce vomiting which may be

prevented by combining with butorphanol or
giving maropitant pre-operatively

– Reversal: Atipamezole
Induction agents
• Propofol – hypnotic

• Dose dependent on effect of premedication

• 2 – 6 mg/kg titrated to effect

Alfaxalone
• Neuroactive steroid

• Calculated/titrated dose over 60 seconds

• Myocardial depression with higher end of dose range

DISSOCIATIVE AGENTS
• Will indirectly stimulate the cardiovascular system by
increasing sympathetic tone

• cause an increase in heart rate, cardiac output,

mean arterial pressure, pulmonary arterial pressure
and central venous pressure.

• Increase in rate causes an increase in myocardial

work and oxygen demand/consumption
Ketamine
• Does not produce a true anesthetic state – disassociation
from the environment with analgesia and sensory loss

• Heart rate and arterial pressure increase due to an

increase in sympathetic tone (CNS derived)

• Peripheral vascular resistance is unchanged

• Prior administration of benzodiazepine, acepromazine

and/or inhalant agents may decrease or prevent
cardiovascular effects
Telazol
• Tiletamine
• Zolazepam - benzodiazepine

• Clinical effects similar to ketamine

• Draw 2mg/kg and titrate to effect

• Prolonged or rough recovery when used as a sole agent

Inhalant anesthetics
• High cardiac output can delay anesthetic induction –
blood flow through the lungs maintains the diffusion
gradient between the alveoli and blood.

• i.e. – slower induction in excited patients vs. more

rapid induction in decreased output patients – shock,
hypovolemia, etc.
MAC
• MAC = minimal alveolar concentration. Produces
immobility in 50% of patients receiving noxious
stimuli

• Varies with agents and species

• The lower the MAC, the higher potency of the

anesthetic agent.
Isoflurane

• MAC for cats is 1.63%

• Heart rate is seen to increase slightly

• Decrease in arterial blood pressure – main cause is

decreased vascular resistance vs decreased cardiac
output
Sevoflurane
• Causes mild myocardial depression (decreased
contractility)

• Mild systemic vascular resistance and arterial blood

pressure depression

• Less likely to see an increase in heart rate,

vasodilation when compared to isoflurane

• MAC for cats = 2.58%

Nursing Care Goals
• Make the cat feel safe and secure in the clinical
setting and at home following discharge

• Minimize stress to the patient during in-clinic and

at-home treatment

• Contribute to successful recovery from illness,

surgery or other treatment, and injury
kwaddell1212@Hotmail.com