Anesthesiology & Pain Management

In the veterinary profession, ?-2 adrenergic receptor agonists (?-2 agonists) are either loved or feared; this is often determined by a veterinarian's familiarity with the drug. There is no doubt that ?-2 agonists have complex effects, but understanding ?-2 agonists increase options for analgesic use, as well as sedation.

Used in veterinary medicine mostly for acute pain. Oral opioids have poor absorption in animals so there is a tendency not to use them in chronic conditions. All opioids have peripheral and central effects.

Local anesthesia is employed prior to all dental procedures. Dental procedures can be very painful. The patient often can feel dental procedures while under inhalation anesthesia.

Synthetic opioids are powerful, useful tools to manage pain for one simple reason: Receptors for naturally-occurring opioids (endorphins, enkephalins) are distributed ubiquitously throughout the body and can be found in both central and peripheral tissues.

Currently, the only analgesics available to veterinarians that prevent pain transmission are local anesthetics, which facilitate a variety of veterinary procedures.

It is now a settled matter that the adaptive capacities of animals, coupled with the innate biases of human observers, seriously impairs our ability to "know" which of our patients are in pain, how much they are in pain, and sometimes, even where they are in pain.

Benefits of pain management in the acute situation

Even in the modern day, opioids remain the cornerstone of analgesia. Aesop's fables gave rise to the saying that "Familiarity breeds contempt"; these drugs are often underappreciated because of their long history as analgesics. Opioids may not be "novel" but they are critical to pain relief and a strategy that our patients benefit from.

Pain can be protective, but through the stress response it may also contribute significantly to patient morbidity and even mortality. Anxiety may contribute directly to the hyperalgesic state through cholecystikinin-mediated "nocebo" effect.

In the last 10 years, the veterinary profession has undergone what can only be described as a sea change in perspectives about animal pain and pain control. A 1993 evaluation of a veterinary teaching hospital surgical caseload revealed only 40% of patients that had undergone highly invasive, painful procedures (including orthopedic repair, thoracotomy, and intervertebral disc decompression) received any sort of pain control, and then only based on clinical signs.

Veterinary pharmacology is increasing in complexity with advances in analgesia. A veterinarian's knowledge of drug interactions is critical to prevention of a potentially harmful event. Drug interactions are considered undesired increases OR decreases in drugs co-administered.

Pain transmission is complex and pain itself is difficult to manage in some cases. While a standardized approach to pain management forms a cornerstone from which to work, there are a variety of analgesic options available with which to provide multimodal analgesia; many veterinarians already have some of these modalities on hand.

Before improving quality of life for patients, a veterinarian must first understand the cause of a decrease in quality of life. Pain is universally accepted as decreasing quality of life but is fairly ambiguously defined; according the International Association for the Study of Pain (IASP), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

What is a neonate or pediatric patient? Neonate patients are between 0 to 6 weeks of life and a pediatric patient is between 6 to 16 weeks of life.

Arterial hypotension is a common anesthetic complication. Perfusion of vital organs depends largely on arterial blood pressure. Mean arterial blood pressure (MAP) below 60 mmHg and systolic blood pressures below 80 mmHg can result in reduced perfusion of the vital organs. Oxygen debt can ensue in morbidity and mortality.

Whenever confronted with a painful animal, one should consider employing a considerable effort to control the pain as best as possible and as early as possible. This is true for both acute and chronic cases of pain.

Non-steroidal anti-inflammatories, or NSAIDs, are unique drugs that provide analgesia by decreasing peripheral inflammatory enzyme conversion and reducing central pain perception.

Maintenance of anesthesia using an inhalant agent has been associated with cardiopulmonary depression. Some small animal patients are more sensitive to the cardiopulmonary depressant effect of inhalant agents.

Most recent estimates suggest there are over 80 million cats in the United States. Many of these cats will undergo a procedure expected to result in pain, underscoring the need for sound pain assessment tools.

What is a geriatric patient? Geriatric patients are pets that have attained 75% of that species or breeds expected life span. Therefore, a 6 year old Yorkshire terrier would not be considered geriatric, but a 6 year old Irish wolfhound would fall under this definition.

The framework of effective pain management systems rests solidly on the foundation of recognition/assessment, pre-emption, and using multiple modalities. Multiple modalities allow for intervention at several different places of the nociceptive pathway, increasing effectiveness and minimizing the need for high or protracted doses of any one particular drug.

There are many physiologic variables that can be monitored in anesthetized small animal patients. The major goal of monitoring an anesthetized patient is to ensure adequate oxygen delivery to the tissue. Appropriate oxygen delivery to the tissue needs the proper functioning of the cardiovascular and respiratory systems.

Probably the most common condition associated with osteoarthritis, post-surgery and musculoskeletal abnormalities. Yet, it is rarely taught in veterinary university settings, few practitioners even know of its existence, all despite the fact that muscles compromise half of an animal's body weight.

The practice of veterinary anesthesia has been impacted by the short supply of propofol and discontinued production of thiopental. Thiopental is officially in the "Discontinued Drug" list of the FDA. The company that used to make thiopental decided to stop production because of its stand against the use of this drug for lethal injections.

To safely anesthetize small animal patients with preexisting cardiac condition, it is important that specific hemodynamic goals are set for the particular heart condition. It is easy to state that for patients with cardiac problem, "heart-friendly" drugs need to be used.

You can never become good at pain management without understanding basic pain pathways. You will have trouble understanding pain pathways without understanding the terminology used to describe them.

Our selection of analgesic options for the feline is influenced by the species' characteristic physiology and individual variation. The increasing popularity of the cat fuels exploration of this complex animal's unique attributes.

The risk of anesthesia is higher in emergency cases compared with elective cases. Most of these patients are compromised and this increases the danger of anesthesia, especially in cases when there is no time to optimize the condition of the patient before anesthesia.

Exotic small mammals (formally known as pocket pets) are challenging creatures to work with. When working with dogs and cats, it is usually easy to place an intravenous catheter, intubate, provide fluid therapy, hook up an ECG, place a blood pressure cuff, and keep track of the core body temperature.

Medical Acupuncture and Chinese Acupuncture