TIVA - Total IntraVenous Anesthesia
TIVA is an attractive option for those patients poorly tolerant of inhalant anesthetics. TIVA can be performed with injectable agents like propofol and alfaxalone or with combinations based upon a mu agonist opioid and a benzodiazepine; most commonly fentanyl and midazolm.
The dose ranges presented by the calculators should be viewed, in a sense, like a vaporizer dial: they establish a framework, a low and high end, to facilitate the dose to effect process. At times the patient may need to be "turned off". At times the patient may need a quick IV bolus of agent to gain control of a "suddenly light" patient.
IM anesthesia is an attractive option in a number of settings including remote locations and spay-neuter clinics. Unfortunately, IM anesthesia is often associated with sacrifices in patient safety; but this does not have to be so.
Once the IM agents are given, the patient should be closely monitored. Once anesthetized, the patient should be intubated and supplemental oxygen initiated. IV catheters and IV fluids are ideal. Once the procedure is complete, alpha-2 antagonists, preferrably atipamezole, should be administered to shorten the time to independent airway protecion.
We promote IM protocols that include flexibility rather than a single rigid protocol applied across a broad patient population; flexibility to adjust to the individual needs of the patient. We suggest protocols that include a mu agonist over those with kappa agonists to improve the overall analgesic impact.
Local Anesthesia - Ring Blocks
Local anesthetics should be applied in almost all surgical situations; they are inexpensive and very low risk when applied correctly. Our protocols include lidocaine for quick onset and bupivacaine for long duration. A mu opioid is included to extend analgesia without extending motor block (as would be expected when corticosteroids are included in local blocks1).
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