Appendix D: Routine Case Protocols

Nancy Shaffran

Routine Cases •  Add gabapentin starting at 10 mg/kg BID if

Dogs (Heart Healthy)
General Surgeries or Painful Procedures
•  Injectable NSAIDs at least 45 min to 1 h prior
to surgery if no contraindications. Patients
must have blood pressure monitored with IV
fluids available as needed to correct hypoten-
sion during surgery.
•  Combine 125 µg/M2 dexmedetomidine (low
premed label dose) with opioid of choice at
standard dose (e.g. hydromorphone at
0.2 kg/kg) and administer IM 15–20 min
prior to induction.
○○ Induction drug volume (propofol, tilet-
amine/zolazepam, or ketamine/diazepam)
should be reduced to half of usual amount
or less. Inhalant anesthesia should also be
reduced by 50% on average for target of
0.5–1% isoflourane.
•  Repeat opioids as needed post operatively for
12–24 h.
•  Discharge on continued NSAIDs (3–4 days
for soft tissue; 1–2 weeks for orthopedics).
neuropathic pain is present.
Short nonpainful or mildly painful
procedures (e.g. radiographs,
laceration repair)
•  Combine 250 µg/M2 (1/2 sedation label dose)
dexmedetomidine with 0.2 mg/kg butorpha-
nol and administer IM or IV.
•  Consider dose of NSAIDs.
○○ Can reverse with equal volume (to dexme-
detomidine) of atipamezole IM.
Mini Micro Rescue Dexmedetomidine
dose for rough recovery
•  Acute Rescue: Administer 1–2 µg/kg IV (0.1–
0.2 cm3 for a 25 kg dog). Provides about
30 min of sedation to transition smoothly
from anesthesia.
•  CRI: Can repeat as needed or deliver as a CRI at
1–3 µg/kg/h

Pain Management for Veterinary Technicians and Nurses, First Edition. Edited by Mary Ellen Goldberg and Nancy Shaffran.
© 2015 John Wiley & Sons, Inc. Published 2015 by John Wiley & Sons, Inc.
Companion Website: www.wiley.com/go/goldbergpainmanagement
396
Appendix D: Routine Case Protocols
Cats
General Surgeries or Painful
Procedures (Kitty Magic)
•  Injectable NSAIDs at least 45 min to 1 h prior
to surgery if no contraindications. Patients
must have blood pressure monitored with IV
fluids available as needed to correct hypoten-
sion during surgery.
•  In a 5 kg cat, combine and administer IM:
○○ 0.2 ml dexmedetomidine
○○ 0.2 ml ketamine
○○ 0.2 ml buprenorphine (0.3 mg/ml)
•  Provides 30 min of profound sedation and
analgesia typically sufficient to perform cas-
tration or less painful procedures or intuba-
tion. Occasionally, small amounts of inhalant
anesthesia by mask are required.
•  Postoperative buprenorphine 0.03 mg/kg IM
or TM Q 8 h as needed.
•  Gabapentin starting at 5 mg/kg BID as needed
for control of neuropathic pain.
Short nonpainful or mildly
painful procedures (Kitty
Magic Lite)
•  0.1 ml dexmedetomidine per 5 kg
•  0.1 ml ketamine per 5 kg
•  0.1 ml torbugesic per 5 kg (10 mg/ml)
Kitty Magic Squirt given transmucosally
for fractious cats
•  0.2 ml dexmedetomidine per 5 kg
•  0.3 ml buprenex per 5 kg (0.3 mg/ml)
•  0.4 ml ketamine per 5 kg
○○ This combination will mimic the effect of
Kitty Magic provided the entire dose is
delivered to the cat’s oral cavity.
397
Appendix D2
Kitty Magic Defined for Trap Neuter
Return Programs
Transmucosal administration of “kitty magic” for
extremely fractious cats who cannot safely receive
an IM injection.
Formula
0.2 ml dexmedetomidine per 5 kg
0.2 ml (0.3 mg/ml) buprenorphine per 5 kg
0.4 ml ketamine per 5 kg
These should be combined and administered
directly into the cat’s mouth to create contact
with the oral mucosa. A short open-ended tom
cat catheter can be placed on the end of the
syringe to facilitate the accuracy of the “squirt”
and to provide safer distance from the cat’s
mouth.
Transmucosal methadone may be able to be
substituted for buprenorphine. Dr. Paulo Steagall
reports, “Clinical experience shows that 0.5 mg/
kg of methadone buccally (OTM) may provide
good postoperative pain when used as part of a
multimodal protocol which is according to
Dr. Ferreira’s study which is an experimental trial.
I have always used the 10 mg/ml injectable formu-
lation. If I am using it for premedication, I usually
go for the 0.2–0.3 mg/kg (IV and IM, respec-
tively). The drug does not cause vomiting or hista-
mine release as one may observe with morphine
nor hyperthermia or dysphoria as observed with
hydromorphone in some cases.”
References
Ferreira, T.H., Rezende, M.L., Mama, K.R., Hudachek,
S.F. & Aguiar, A.J. (June 2011) Plasma concentra-
tions and behavioral, antinociceptive, and physio-
logic effects of methadone after ­ intravenous and
398
oral transmucosal administration in cats. Am J Vet
Res, 72 (6), 764–771.
Grove, D.M. & Ramsey, E.C. (2000) Sedative and phys-
iologic effects of orally administered α2-adrenoceptor
agonists and ketamine in cats. J Am Vet Med Assoc,
216 (12), 1929–1932.
Appendix D: Routine Case Protocols
Robertson, S.A., Lascelles, B.D., Taylor, P.M. & Sear, J.W.
(October 2005) PK–PD modeling of buprenorphine in
cats: intravenous and oral transmucosal administration.
J Vet Pharmacol Ther, 28 (5), 453–460.