Routine anesthetic chamber use is not in your patient's or staff's best
interest. So how do you wean off the chamber and move to more patient and
staff friendly injectable strategy?
It is a matter of timing, equipment, and medication selection. Tough cats are 100 times easier to manage if you have a well conceived sedative/analgesic combination all prepared in advance. You
whisk the cat into an exam room as soon as they walk in the practice door.
Make sure the room always has a Feloway diffuser in it. Pop the top off of
the carrier, cover the cat with a Feloway towel, press him/her down firmly from above, lift the rear cover and
inject the combination into the epaxial muscles IM before he/she knows
what has happened. Then darken and leave the room. Check back in 5 to 10 minutes
but also ask the owner to open the door if the cat looks sleepy sooner.
If they're in a cage, use the Wild Child or the EZ Nabber to collect them,
give the epaxial IM injection (make sure a few mg/kg ketamine are included
if they are all wound up) and release them to chill out. Cover cage with Feloway towel and make sure the bedding in the cage has
Feloway spray on it.
If they are healthy I use butorphanol 0.2 mg/kg for nonpainful
procedural sedation OR hydromorphone 0.1 mg/kg if performing a painful
procedure. I combine one of these two opioids with 0.2 mg/kg midazolam AND
(dex)medetomiidne. The medetomidine dose range is 0.002 to 0.015 mg/kg.
Dexmedetomidine dose range is 0.001 to 0.0075 mg/kg. I do NOT like to use
acepromazine when managing these patients.
If they are absolute killers, especially if they are already wound up,
I add 1 to 3 mg/kg ketamine.
If they are cardiac patients I leave the (dex)medetomidine out and add
the 1 to 3 mg/kg ketamine to the opioid and midazolam. The exception is
the hypertrophic cardiomyopathy cat with left ventricular outflow track
obstruction. These patients appear to beenfit from the inclusion of
(dex)medetomidine.1
This works great for fractious but healthy healthy outpatient routine
appointments. For the outpatients I use butorphanol, midazolam, and (dex)medetomidine.
Once done we give the atipamezole IM at 1/2 (dex)medetomidine volume and
they're usually ready to roll in 10 minutes. Often the owners tell me how
happy they were with this compassionate patient management stating that
the cats are often extra-affectionate after these sedative events.
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