Month 3 Schedule – The Neuter and Trends

Caroline writes:
Hello Dr. Brock,

I have a couple of questions regarding my anesthesia protocols:

Ketamine for Feline Spays: Do you recommend using ketamine boluses during cat spays as well? I typically use them during canine spays, specifically when working on the pedicles.

Induction Protocols: Does ketamine need to be part of the induction protocol for the intraoperative boluses to be effective? Previously, I used a ketamine/propofol combination for induction followed by ketamine boluses. However, at my new practice, the technicians prefer inducing with Alfaxalone only, so I am no longer using ketamine during the induction phase.

Great questions! Yes I use ketamine in the same way for both cat and dog spay procedures. But if you are not witnessing the increase in heart and respiratory rates that accompany traction on the ovarian pedicles then I suggest that you don't need the ketamine IV bolus, there is nothing to "fix". If you are observing that the cats in your practice don't respond to ovarian pedicle traction the same way as dogs, the reason may be in the differences between your canine and feline spay premed protocols: many cats receive large doses of ketamine and dexmedetomidine in their premeds which may blunt their reponse to surgical manipulation.

Ketamine does not need to be part of the induction protocol for the peri-operatve IV ketamine bolus to be effective. Using ketamine during induction can provide two benefits 1) immediate intense brief analgesia that can help with handling an acutely painful patient in the first 10 minutes or so of unconsciousness, for example, the dog with acute fracture pain being handled and positioned for placement of regional blocks. 2) Reduction in the total dose of propofol that is required for intubation which MAY reduce the severity and duration of post induction apnea and hypotension.

Hi Dr. Brock,
I was wondering if I could ask a question about a reply you had given last month to a colleague's question about a feline neuter anesthetic protocol for a cat with a heart murmur. You had mentioned at the end: "Listen carefully for upper respiratory noises such as gurgling both before and also in the half hour or so after extubation and treat with IM glycopyrrolate at 0.01mg/kg." I do sometimes hear this in feline patients after extubation during neuter procedures, (does not occur in patients we do IM sedation for other procedures and are not intubated). I was told or assumed it may be due to the lidocaine spray upon intubation and we tell clients this should resolve within 24-48h. Should I be treating this with glycopyrrolate and is the lidocaine spray the actual reason for this??

A question for Dr. Sylvestre also: I was just looking for the spay and neuter workshop to see if I could watch the cryptorchid videos, do we still have access to this?

Thank you very much,
Tina