TUFTS SAH ANESTHESIA SECTION DOSE LIST - 3/21/2022

PREMEDICATION (¥=Use ½ dose IV or admin drugs IV to effect).

Usual dose is in italics and parentheses.
Acepromazine 10 mg/ml (or 1 mg/ml dilution) 0.01-0.05 mg/kg (max. 3.0 mg/Dog) ¥ (0.03)
Alfaxalone 10 mg/ml 1-2 mg/kg (cat - 1.5, dog - 1) IM only for premed
Atropine 0.4 mg/ml 0.02-0.04 mg/kg (0.02)
Buprenorphine 0.3 mg/ml 0.01-0.02 mg/kg (0.01) may use higher dose in cats
Butorphanol 10 mg/ml 0.1-0.4 mg/kg (0.2)
Dexmedetomidine 500 g/ml (or 50g/ml dilution) 1-15 µg/kg ¥ (5)
Diazepam 5 mg/ml 0.1-0.5 mg/kg (0.2)
Fentanyl 50 g/ml 2-10 g /kg (3-5)
Glycopyrrolate 0.2 mg/ml 0.01-0.02 mg/kg (0.01)
Hydromorphone 10 mg/ml 0.1-0.2 mg/kg (0.1)
Ketamine 100 mg/ml 3-20 mg/kg (cat - 8, dog - 4)
Methadone 10 mg/ml 0.2-0.5 mg/kg (0.3)
Midazolam 5 mg/ml 0.1-0.2 mg/kg (0.2)
Morphine 10 mg/ml 0.5-1 mg/kg (1) [IV may cause histamine release
USEFUL PREMED COMBINATIONS other than BAA, OBAA, or BMA:
- Hydromorphone 0.1-0.2 mg/kg with Diazepam or Midazolam 0.1-0.2 mg/kg
OR with Acepromazine 0.025-0.05 mg/kg. Use of an opioid + 2 tranquilizers at low doses is also effective
- In cats, the addition of alfaxalone 1.5 mg/kg IM to a less sedating premed (e.g. butorphanol 0.2mg/kg +/-
midazolam 0.1-0.2) can improve sedation
- Butorphanol 0.2 mg/kg + Dexmedetomidine 5-8 µg/kg (give half IV, more if additional sedation required)
Reverse (only if needed) with IM Atipamezole (volume = ½-1 x Dexmedetomidine volume administered)
INDUCTION (all dosages are for IV administration and
should be titrated TO EFFECT)
Ketamine/Diazepam or Midazolam 5.5 mg/kg / 0.28 mg/kg or 0.5 ml of each/9 kg
Ketamine/Midazolam/Fentanyl (technique for CV 2.2 mg/kg / 0.11 mg/kg / 3.3 ug/kg or 0.2 ml of
unstable patients only) ketamine + 0.2 ml midazolam + 0.6 ml of
fentanyl/9 kg (1:1:3 mix by volume)
Hydromorphone /Diazepam or Midazolam 0.1-0.2 mg/kg of each
Propofol 10 mg/ml 4 mg/kg w/premed, 8 mg/kg no premed
Alfaxalone 10 mg/ml 1.5-2.5 mg/kg dog; 3-4 mg/kg cat
Etomidate 2 mg/ml 0.5-1.5 mg/kg with significant premedication
Ketamine+ Propofol 1-3 mg/kg + 3-2 mg/kg
Isoflurane Gradually  vaporizer setting from 0 to 4%
Sevoflurane Gradually  vaporizer setting from 0 to 5%

MAINTENANCE
Inhalation Agents MAC 1.5 x MAC
Isoflurane 1.2% 1.8%
Sevoflurane 2.3% 3.5%
Injectable Agents
Hydromorphone 0.05 mg/kg every 60 -90 minutes
Ketamine 1-2 mg/kg + diazepam 0.2 mg/kg as needed (q 30 min)
Alfaxalone 0.07 mg/kg/min to effect (CRI)
Propofol 0.1-0.4 mg/kg/min to effect (CRI)
Fentanyl 0.2-0.5 g/kg/min (CRI, support ventilation)
Dexmedetomidine 0.1-1 ug/kg/hr (CRI)
Neuromuscular Blocking Agents - repeat only
if necessary 0.25 mg/kg IV for initial dose, then 0.1 mg/kg for
Atracurium 10 mg/ml additional doses

Reversal of Neuromuscular Blocking Agents Atro. 0.02 mg/kg (IV) or Glyco. 0.01 mg/kg (IV) prior to
Atropine or Glycopyrrolate followed by Neostigmine 0.02-0.06 mg/kg (IV) (0.02 usually
Neostigmine (0.5mg/ml) adequate). Give time for HR to  before Neostig.

1
OTHER REVERSAL AGENTS
Naloxone (opioid reversal) 0.4 mg/ml
Butorphanol (opioid pure agonist reversal)
Yohimbine (2 agonist reversal) 2.0 mg/ml
Tolazoline (α2 agonist reversal) 100 mg/ml
Flumazenil (benzodiazepine reversal)
0.1 mg/ml
Atipamezole (2 agonist reversal) 5 mg/ml
SMALL ANIMAL PREMIX FORMULA
OBAA Dose: 0.1 ml/kg IM or SQ
½ dose IV
BAA Dose: 0.1 ml/kg IM or SQ
½ dose IV
BMA Dose: 0.2 ml/kg IM or SQ
½ dose IV
INTRAOPERATIVE MLK FORMULA FOR DOGS
MLK Dose: 5 ml/kg/hr IV
(anesthesia fluid rate only)
Can be given at 10 ml/kg/hr for fluid
deficient patients by doubling the size of
the fluid bag and using the same number
of mg listed.
2
0.003-0.01 mg/kg IM or IV SLOWLY TO EFFECT over 1-5
mins. Watch for later re-narcotization!
0.05-0.1 mg/kg IM or IV SLOWLY TO EFFECT
0.11 mg/kg IM or IV SLOWLY TO EFFECT
2 mg/kg IM or IV SLOWLY TO EFFECT
0.01mg/kg SLOWLY TO EFFECT over 5 min
5-10 x Dexmedetomidine dose (mg) administered. This
is a volume between ½ and -equal to the
Dexmedetomidine volume. Give IM only, unless intraop
or during an arrest. When administered
intraoperatively, dilute it and administer it slowly IV
over 5 minutes, stopping when the desired effect has
been achieved.
100 mg Butorphanol (0.2 mg/kg)
12.5 mg Acepromazine (0.025 mg/kg)
10 mg Atropine (0.02 mg/kg)
q.s to 50 ml with 0.9% saline
100 mg Butorphanol (0.2 mg/kg)
25 mg Acepromazine (0.05 mg/kg)
10 mg Atropine (0.02 mg/kg)
q.s to 50 ml with 0.9% saline
50 mg Butorphanol (0.2 mg/kg)
50 mg Midazolam (0.2 mg/kg)
5 mg Atropine (0.02 mg/kg)
q.s to 50 ml with 0.9% saline
24 mg Morphine Sulfate (0.24 mg/kg/hr)
300 mg Lidocaine (50 g/kg/min)
60 mg Ketamine (0.6 mg/kg/hr)
add to 500 ml bag LRS
 VARIATIONS ON AN IM COMBINATION FOR HEALTHY CATS
Various combinations of ketamine,
dexmedetomidine and either butorphanol
or buprenorphine. A quite profound
sedative-dissociative combination that can
be varied, depending on the extent of and
painfulness of the procedure.
The combination of low dose of ketamine
and strong sedation and analgesia can be
used for radiographs, pin removals, other
minor procedures.
This is a “healthy cat” combination, not
suitable for debilitated or compromised
animals.
NOTE: Onset of action can be very quick
and profound for young cats.
For older or less healthy cats, a variation
on the following protocol can be used.
Notes on Variations
Standard Dose
Ketamine 2 mg/kg,
Ketamine can be increased to
Butorphanol 0.2 mg/kg,
up to 8 mg/kg; cats are able to
Dexmedetomidine 10 ug/kg
be intubated on this.
IM
Buprenorphine 0.01 mg/kg
This is equivalent to 0.1 ml of
substituted for butorphanol
each in a 5 kg cat.
(lengthen onset time, prolong
Recovery will be accelerated analgesia).
with Atipamezole but may
result in head tremors due to
ketamine.
Consider supplement oxygen. Our current cat neuter dose is:
Ketamine 5 mg/kg
For less profound sedation: Butorphanol 0.2 mg/kg
Ketamine 7-10 mg/kg Dexmedetomidine 8 ug/kg
Diazepam or midaz 0.2 mg/kg
Glycopyrrolate 0.01 mg/kg
Butorphanol and midazolam
Alfaxalone 1.5-2 mg/kg
may be enough for more
Midazolam 0.2 mg/kg
debilitated cats. Adding
Butorphanol 0.2 mg/kg or
alfaxalone will provide more
Hydromorphone 0.1 mg/kg
extreme sedation.

DR KARAS’S “CHILL PROTOCOL” FOR DOGS AND CATS

PM before visit Gabapentin PO DOSES:
Gabapentin: 20 mg/kg PO
Melatonin: big dog (100lbs) 5 mg
Morning when awake Gabapentin PO
Medium dog 1 mg
Melatonin PO
Cat/Small dog 0.5 mg
Morning 30 min before travel Ace OTM Acepromazine: Young healthy dogs and cats 0.05 mg/kg
to vet Middle age/mild comorbidities 0.025 mg/kg
Geriatric/ sensitive breeds 0.01 mg/kg