Local & Regional Anaesthesia (Analgesia) Metode Anestesi Lokal. Agent. download from

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1 Local & Regional Anaesthesia (Analgesia) Purely analgesic techniques Drh. Budhy J. Widyananta Agent 2% Lidocaine hydrochloride 2% Mepivicaine hydrochloride rapid onset slighty longer duration slightly less tissue reaction Metode Anestesi Lokal Anestesi topikal Anestesi infiltrasi Anestesi regional/perineural Anestesi intraartikular Anestesi sub sinovial 1

2 Anestesi Lokal Ruminansia Anestesi infiltrasi Anestesi proximal paravertebral Anestesi distal paravertebral Anestesi epidural segmental dorsolumbar Jenis Bedah abdomen : rumenotomi, cecotomi, operasi GI displacement, obstruksi intestin, volvulus, caesar, ovariectomi, biopsi ginjal dan hati Line block Anestesi infiltrasi Suntik kulit, otot, peritoneum Jarum 20G atau kurang untuk kulit : 2,5cm Jarum 18G utk lapisan di bawah kulit : 7,5 10cm 50ml lidocaine 2% 0,5 1ml tiap 1 2cm Regional Analgesia Inverted L Block Target : laparotomy flank / laparotomy paramedian Vertikal : sepanjang costae terakhir (T13) Horizontal : L1 L4L4 Hingga 100ml lidocain 2% Jarum 18G Wait minutes Paravertebral / Paralumbal Block Paravertebral / Farguharson method Paralumbal / Magda s method Target : Skin, fascia, muscle & peritoneum of the flank Back leg (Block L3, miscounted L4) 2

3 Anestesi proximal paravertebral (Ferquharson methods) Sapi 2,5 5cm dari midline Jarum 14G, 16G, 18G 20ml Lidocaine 2% (15ml di ligament, 5ml di atasnya) T13, L1, L2 transverse process Sudut injeksi 90derajat Domba dan kambing 2,5 3cm dari midline 2 3ml lidocaine 2% Anestesi distal paravertebral (Magda, Cakala, Cornell Methods) Distal prosesus lumbalis L1, L2, L4 lumbal transverse process Jarum 18G 10 20ml lidocain 2% Suntik di vental dan dorsal prosesus transversus Epidural Analgesia Caudal (Low) Target : anus, vulva, perineum, caudal thighs, anal sphincter & rectum intercoccygeal vertebrae (1 & 2) or sacrococcigeal space 45 O angle 0,5 1 ml/45 kg Lower dose first Wait min Add more solution 3

4 Cranial/High Target : laparotomy, pelvic limb surgery, udder amputation Duration : 2 4 hrs Same technique 1ml/4,5kg Animal go down sternal recumbency >150ml hipotensi Equine species Caudal epidural block, nerve block, ring block Cranial epidural injection is contra indicated in horses. Caudal epidural injection in horses Angle : 30 or 60 Initally 5 10 ml The needle islf leftinplace to add more Nerve Block 4

5 Joint Block General Anaesthesia Assessment History : Vomit, recent meal postphone p 6 8hrs food withhold do not withhold water cough/exercise intolerance cardiopulm polyuri/polydypsi endocrine/renal Weight Obesse Physical examination : cardiopulmonary traumatized bleeding, pneumothorax abnormality by auscultation, percussion, palpation, MM radiography, ECG Blood test : PCV, TP hemorrhage BUN, creatinine (>7 yrs) renal 5

6 Atropine Sulfate Anticholinergic Pre anesthesi bronchodilator organophosphate poisoning (antidota) meningkatkan HR menghambat sekresi saliva Drowsiness Atropin sulfat (IM,SC,IV) Dosis : 0,01 0,02 mg/lb Durasi : 60 90mnt Dogs: mg/kg (IM, IV or SC) Cats : mg/kg (IM, IV, SC) 0,25 Rabbits : 0,04 2mg/kg Sheep/goat : 0,15 0,3 mg/kg (IM) Tidak direkomendasikan untuk ruminansia Pada kuda dapat menyebabkan kolik Glycopyrolat (IM, SC, IV) Dosis : 0,005mg/lb Durasi : 2 4jam Acepromazine Maleate Pre medication/phenotiazine Pre anesthesia Restrain/sedation/menenangkan Reduce anxiety in painful patient /mengurangi kekejangan not an analgesia Anti itchy antiemetic Hypothermia Doses Dogs: Pre med : 0,03 0,05mg/kg (IM), 1 3 mg/kg (PO) 1 hr before Pre anes : 0, mg/kg max 3 mg/kg (IV, IM, SC) Restrain/Sedation : 0,025 0,2 mg/kg max 3 mg/kg (IM) Reduce anxiety : 0,05mg/kg max 1 mg/kg (IV, IM, SC) Cats : Restrain/Sedation : 0,02 0,1 mg/kg max 1 mg/kg (IM) Restrain/Sedation : 0,02 0,1 mg/kg max 1 mg/kg (IM) Reduce anxiety : 0,05mg/kg max 1 mg/kg (IV, IM, SC) Side effect Bradicardia, hypotensi, penis injured (stallion), prolaps membrana nictitans, respon stimulus meningkat 6

7 anjing kucing kuda sapi kambing Acp ,05 0, ,05 0, , , ,02 (mg/lb) 0,04 0,04 0,04 diazepam 0,1 0,2 0,1 0,2 0,01 0,004 0,01 0,04 0,01 0,04 Doses Rabbit: Tranquilizer : 1 mg/kg (IM) Premedication : mg/kg (SC) mg/kg (IV, IM, SC) Mice, Rats, Hamsters, Guinea Pigs, Chinchillas : 0.5 mg/kg (IM) Sheep/Goat: mg/kg (IM) Xilazine Sedation Muscle relaxan Analgesia (minor procedures) Pre anesthesi Side effect Vomit (dogs 25%, cats 50%) Bradycardia, decrease RR Not indicated : cardiac, liver, kidney, shock Doses Dogs: mg/kg (IM, SC) 1.1 mg/kg (IV) Cats : mg/kg (IM, SC) 1.1 mg/kg (IV) Rabbits : xylazine 5 mg/kg (SC, IM) + ketamine 35 mg/kg GA 13 /k (IP) kt i 87 /k GA : 13 mg/kg (IP) + ketamine 87 mg/kg Sheep/goat mg/kg (IV) mg/kg (IM) 7

8 Medetomidine Xilazine (mg/lb) anjing kucing kuda sapi kambing 0,2 0,5 0,2 0,5 0,2 0,5 0,01 0,05 0,01 0,03 Sedation Muscle relaxan Analgesia (minor procedures) Pre anesthesi Side effect 100 times more poten than xilazine Longer duration Bradycardia, decrease RR Not indicated : cardiac, liver, kidney, shock Ketamine HCl anjing kucing kuda sapi kambing Medetomidin 0,005 0,01 0,01 0,02 0,005 0,01 (mg/lb) Detomidin 5 10ug/lb 1 5ug/lb Restraint Sole Anesthaetic Analgesia Side effect Ap/dyspnea, convulsion, muscular tremor, hyperthermi, hypersalivation, tachicardia, Maintain swallowing and ocular reflexes 8

9 Doses Dogs: Anesthesia: Xylazine 2.2 mg/kg, 10 minutes prior to ketamine 11 mg/kg (IM) Atrophin mg/kg (IV, IM, SC), 15 minutes prior to xylazine 1.1 mg/kg (IM), 5 minutes prior to ketamine 22 mg/kg (IM) Cats : Restraint : 11 mg/kg (IM) 0.1 ml/kg =10 mg/kg (IV) Anesthesia : Atropine 0,022 0,044 mg/kg (IV, IM, SC) Xylazine: 1,1 mg/kg (IV) or 1,1 2,2 mg/kg (IM, SC) Ketamine: 2,2 4,4 mg/kg (IV) or mg/kg (IM) For 22.7 kg above reduce 25% of dose Rabbits : Alone: mg/kg (IM) or mg/kg IV Combination ketamin 10 mg/kg + xylazine 3 mg/kg (IV) or Diazepam 5 10 mg/kg (IM), 30 minute prior to ketamine mg/kg Sheep: Premedication : atropine 0.22 mg/kg + acepromazine 0.55 mg/kg +ketamine22mg/kg(im) Top up 2 4 mg/kg (IV) Goats : atropine 0.4 mg/kg, minutes prior to xylazine 0.22 mg/kg, 10 minutes prior to ketamine 11 mg/kg (IM) Top up 2 4mg/kg(IV) 9

10 Yohimbine Reverse effects of xylazine Doses Dogs : 0.11 mg/kg (slow IV) Rabbits : 0.2 mg/kg (IV) Common Dose Dog/Cat Atrophine : 0,025 Xylazine 2% : 0,1 ml/kg Ketamin 10 % : 0,1 ml/kg Dexamethasone : 0,1 mg/kg Max 1 mg/kg Ampicillin : 25 mg/kg Only carprofen is the safest NSAID currently available Horse Xylazine 1,0 mg/kg IV 20 mg/kg IM Wait 5 10 min Ketamin 2 mg/kg IV Sedation doesn t adequate : Re dose Xl Xylazine Butorphanol Diazepam Ketamin 10

11 Monitoring anesthetized patient Every 5 min Anesthetic record Heart rate RR CRT MM Reflexes : toe pinch Jaw tone dissosiative not produce muscle relaxan Equipment 11