Drug Combinations for Safer, More Balanced Anesthesia

Kristen Cooley, BA, CVT, VTS (Anes/Analgesia), instructional specialist at the University of Wisconsin School of Veterinary Medicine, describes some of her favorite drug combinations to provide safer and more balanced anesthesia for veterinary patients.

"Drug combinations that I like—to provide safer and more balanced anesthesia—I think the safe part is what you're comfortable with, and then utilizing lower doses, a variety of drugs, and different techniques is the definition of balanced anesthesia. So, we want to focus on that.

I'm a huge fan of dexmedetomidine because when we're talking about anesthetic drugs, we want to use things that we can control. So, a drug like dexmedetomidine is the ultimate drug in that sense because you can see effects based on dose. If you are looking for a lot of sedation or anesthesia, you use a higher dose. If you're looking for anxiolysis, you would use a lower dose. If you are not afraid of side effects, you can go higher. If you want to minimize those side effects, you go lower. And if you don't like what you see, you can reverse it. And that makes it so you have the ultimate control over that drug. So, I like to utilize dexmedetomidine whenever possible because not only does it provide sedation and anxiolysis, but it also provides analgesia which is unlike any other sedative.

So, utilizing, even now that opioids are kind of not as readily available, but drugs like butorphanol are—butorphanol is only a mild analgesic—but if we couple it with dexmedetomidine, we're providing a different level of analgesia and really good sedation, and so that combination is relatively safe and well tolerated by most patients.

And so, I would prefer a pure mu agonist opioid like hydromorphone, but because not everybody can get their hands on that something like butorphanol and dexmedetomidin would be a decent choice, as well."