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http://www.vasg.org/k_drugs.htm

http://www.vasg.org/l_drugs.htm

K

 

1)   KETAMINE

a)      Classification

i)        Dissociative injectable anesthetic agent

b)      General Information

i)        Usually combined with Acepromazine or a Benzodiazepine (Diazepam or Midazolam) for induction

ii)       Provides analgesia at low doses when used in conjunction with an opioid agent

c)      Advantages/Recommended use

i)        Routine induction

ii)       Reasonable choice for stable valvular heart disease patients

iii)     Give 5 mg/lb orally for fractious cats

d)      Cautionary Information

i)        Avoid if:

(1)   History of seizures

(2)   Intracranial disease is suspected

(3)   Significant renal disease is present

ii)       Corneal desiccation can occur

(1)   Corneal protection is required

iii)     Initially causes myocardial depression generally followed by indirect sympathetic stimulation

(1)   Increased heart rate can be detrimental for:

(a)    Hypertrophic cardiomyopathy

(b)   Hyperthyroid patients

(c)    Pheochromocytomas

e)      Dosage Information

i)        Routine induction - Ketamine & Diazepam

(1)   Dog & Cat

(a)    Draw up 1.0 ml of 50/50 mixture per 20lb

(i)      Give initially, then to effect

(ii)    Reduce dose by 30% - 50% if depressed or heavily sedated by pre-meds

(b)   2 mg/kg (1 mg/lb) lidocaine bolus may be administered to dogs following initial ketamine/diazepam bolus to reduce total ketamine/diazepam need

(c)    Keep the unused agent with the patient in the event that the endotracheal tube is dislodged, the patient suddenly becomes very light, etc.

(2)   IM/SC use - not recommended as diazepam can be painful and less predictably absorbed

(a)    Diazepam contains propylene glycol

ii)       Routine induction - Ketamine & Midazolam

(1)   Cats

(a)    Ketamine 5 to 10 mg/kg (2.5 to 5 mg/lb)

(i)      For younger, fractious cats use 10 mg/kg (5 mg/lb)

(ii)    For quiet, older cats reduce ketamine to 5 to 8 mg/kg (2.5 to 4 mg/lb)

(b)   Midazolam 0.2 to 0.4 mg/kg (0.1 to 0.2 mg/lb)

(c)    Mix together in same syringe and give IM

(2)   Dogs the expense of midazolam makes this unattractive for use in dogs

f)       Cost

i)        Low (for ketamine alone and for ketamine/diazepam combined)

 


2)   KETOPROFEN

a)      Classification

i)        An NSAID

b)      General Information

i)        Effective anti-inflammatory/analgesic with significant GI side effects if used long term

c)      Advantages/Recommended use

i)        Long acting analgesic injectable for single dose post-op use

(1)   Duration of effect is 12 to 18 hours

(2)   Single dose post-op usage has been shown to be free of any side-effect concerns in normal dogs and cats

d)      Cautionary Information

i)        Avoid long term use

(1)   GI side effects can be substantial

ii)       Avoid use in combination with corticosteroids

(1)   Potentially increased ulcerogenic effect

iii)     Avoid in renal compromised patients

iv)     Avoid in dehydrated or hypotensive patients

e)      Dosage Information

i)        Dogs 2.0 mg/kg (0.9 mg/lb) SC one time only

ii)       Cats 2.0 mg/kg (0.9 mg/lb) SC one time only

f)       Cost

i)        Very low

 

 

 


L

 

1)   LIDOCAINE

a)      Classification

i)        Local anesthetic and anti-arrhythmic agent

b)      General Information

i)        Quick onset

(1)   5 to 10 minutes

ii)       Short duration

(1)   About 1 to 2 hours

(2)   Combine with bupivacaine and either 0.075 mg/kg (0.035 mg/lb) morphine or 0.003 mg/kg (0.0015 mg/lb) buprenorphine to extend the analgesic duration of local blocks to approximately 20 hours1,2

c)      Advantages/Recommended use

i)        Local blocks for:

(1)   Declaws

(2)   Oral surgery

(3)   Dermal growths

(4)   Joint infusion

ii)       Topical anesthesia for:

(1)   Laryngeal desensitization to facilitate intubation

iii)     IV use:

(1)    To deepen anesthetic plane in dogs after initial induction agents given

(a)    Helps to minimize total induction agent need

(2)   As part of a CRI analgesic strategy

(a)    See CRI section for details

d)      Cautionary Information

i)        Potential CNS toxicity

(1)   Usually manifests as seizure activity if awake, cardiac depression when anesthetized

e)      Dosage Information

i)        Local blocks

(1)   Dogs and Cats 1 to 4 mg/kg (0.5 to 2.0 mg/lb)

(2)   For awake patients, mix 0.9 cc Lidocaine, 0.1 cc sodium bicarbonate, and 2 cc of  sterile water

(a)    Reduced sting

ii)       IV induction enhancement

(1)   Dogs only 2.0 mg/kg (1.0 mg/kg) IV after initial induction agent

iii)     Intra-articular

(1)   Generally whatever will fit after joint closure

(a)    Dogs up to 6.0 mg/kg (3.0 mg/lb)

(i)      Generally 4 to 6 ml total volume

(b)   Cats up to 4.0 mg/kg (2.0 mg/lb)

iv)     Epidural

(1)   Dogs and Cats 4.0 mg/kg (2.0 mg/lb)

v)      Other uses

(1)   Intercostal blocks

(2)   Brachial plexus blocks

(3)   Ringblocks

(4)   Dental Blocks

(5)   CRI Infusions (exercise caution in cats)

f)       Cost

i)        Very low

1 Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Candido KD, Winnie AP, Ghaleb AH, Fattouh MW, Franco CD: Reg Anesth Pain Med. 2002 Mar-Apr;27(2):162-7
2 The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil. Bazin JE, Massoni C, Bruelle P, Fenies V, Groslier D, Schoeffler P: Anaesthesia. 1997 Sep;52(9):858-62

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