Anaesthesia and sedation of the cardiac patient

• Canine sedation/pre-med

  Butorphanol is often enough e.g. for radiography.

  Benzodiazepines (e.g. diazepam, midazolam)

  Plus one off;

  Butorphanol

  Buprenorphine
• Dog induction and maintenance.

  Propofol

  Alfaxalone
• Anaesthesia of cats

  Much harder as give no warning when they are going into heart failure. A lot of cats have heart murmurs but not all of them have structural heart disease.
• Murmurs in cats

  Many innocent murmurs - no pathology.

  Cats with heart failure often have no murmur.

  Cats with heart failure often have a normal/low HR.

  Cats with heart disease might live quite a long time.

  No advantage in the cat in knowing they have structural heart disease as you do not treat cats until they are in heart failure.
• How to spot heart disease in cats?

  Heart disease in cats is a diastolic disease (the heart can not fill). So the atria often get big (easy to spot).

  Spontaneous echo contrast (smoke)/thrombus.
• GA risk in cats

  Decompensation - in many cases we only know the cat has heart disease 3 or 4 days after;

  GA

  Fluid therapy

  Corticosteroid use - usually depot.

  We induce heart failure in one third of cats by doing one of these three things.
• Feline sedation/pre-med for cardiovascular disease

  Gabapentin 1 hour before travel.

  Butorphanol is often enough as sedation, e.g. for radiographs.

  Butorphanol 0.2mg/kg

  Midazolam 0.2mg/kg

  Alfaxalone 0.5mg/kg