Recognizing Patient Trends: When to Watch and When to Intervene
World Small Animal Veterinary Association World Congress Proceedings, 2015
V. Lukasik, DVM, DACVAA
Southwest Veterinary Anesthesiology, Tucson, AZ, USA

Emergency Drugs

Atropine

Bradycardia.

 Dogs: 0.04 mg/kg IM or 0.01 mg/kg IV

 Cats: 0.04 mg/kg IM or 0.01 mg/kg IV

Give one-tenth to one-quarter of the calculated dose IV, chase with an IV fluid bolus, and wait 15 to 30 seconds for a response. Profound tachycardia may occur with IV dosing. Wait it out, it will only last a few minutes. Provide IPPV if necessary. If atropine is unsuccessful, glycopyrrolate may administered.

Lidocaine

Runs of ventricular premature contractions (VPC), ventricular tachycardia, multiple VPCs that are affecting blood pressure.

 Dogs: 4 mg/kg IV slowly

 Cats: 2 mg/kg IV slowly

May repeat dosing every 10 to 15 minutes or start an infusion 25 to 80 μg/kg/min in dogs or 10 to 40 μg/kg/min in cats.

Epinephrine

Asystole (not ventricular fibrillation).

Administer very slowly (in 0.01 to 0.05 ml increments every 10 to 15 seconds) while bolusing IV fluids.

 Dogs: low dose 0.05 mg/kg IV, high dose 0.5 mg/kg IV

 Cats: low dose 0.05 mg/kg IV, high dose 0.5 mg/kg IV

Therapies for Hypotension

 Decrease the depth of anesthesia

 Reduce the vaporizer setting

 Increase the oxygen flow for one to two minutes.

Bolus IV Isotonic Crystalloids (Caution in Cardiac Patients)

 Boluses are 3 to 10 ml/kg IV

 Reassess arterial blood pressure

 Repeat if necessary once only

 If not responsive to crystalloid boluses, or short lived response, go to next steps

6% Hetastarch (Caution in Cardiac Patients)

 Bolus 5 to 10 ml/kg IV for dogs and 1 to 5 ml/kg IV for cats

 Reassess arterial blood pressure

 Repeat once if necessary for a total dose of 10 to 15 ml/kg IV

 If not responsive or not enough, go to vasopressor or inotrope CRI

Vasopressor or inotrope therapy

Drug

Contractility

Heart rate

Vascular tone

IV dose

Dobutamine

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-

5–20 mcg/kg/min

Dopamine

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5–20 mcg/kg/min

Epinephrine

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0.1–1 mcg/kg/min

Norepinephrine

0

No change

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0.2–2 mcg/kg/min

Phenylephrine

0

-

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1–5 mcg/kg/min

Vasopressin

0

-

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0.5 units/kg

Dobutamine 12.5 mg/ml

Dose is 5 to 20 mcg/kg/min, which is 0.3 to 1.2 mg/kg/h IV. Dilute 1.5 ml of dobutamine in 60 ml of 0.9% NaCl, giving a dilution of 300 mcg/ml. Start CRI at 1 ml/kg/h, which is a dose of 5 mcg/kg/min. Increase up to 4 ml/kg/h IV, or decrease, as necessary to maintain acceptable ABP.

Phenylephrine 10 mg/ml

Dose is 0.001 to 0.004 mg/kg IV then CRI of 1 to 5 mcg/kg/min, which is 0.06 to 0.3 mg/kg/h IV. Dilute 0.36 ml of phenylephrine in 60 ml of 0.9% NaCl, giving a dilution of 60 mcg/ml. Start CRI at 1 ml/kg/h, which is a dose of 1 mcg/kg/min. Increase up to 5 ml/kg/h IV, or decrease, as necessary to maintain acceptable ABP.

Ephedrine 50 mg/ml

Dose is 0.1 to 0.2 mg/kg IV then CRI of 5 to 10 mcg/kg/min, which is 0.3 to 0.6 mg/kg/h IV. Dilute 0.36 ml of ephedrine in 60 ml of 0.9% NaCl, giving a dilution of 300 mcg/ml. Start CRI at 1 ml/kg/h, which is a dose of 5 mcg/kg/min. Increase up to 2 ml/kg/h IV, or decrease, as necessary to maintain acceptable ABP.

Norepinephrine 1 mg/ml

Dose is 0.2 to 2 mcg/kg/min, which is 0.012 to 0.12 mg/kg/h IV. Dilute 1.45 ml of norepinephrine in 60 ml of 0.9% NaCl, giving a dilution of 24 mcg/ml. Start CRI at 0.5 ml/kg/h, which is a dose of 0.2 mcg/kg/min. Increase up to 5 ml/kg/h IV, or decrease, as necessary to maintain acceptable ABP.

Vasopressin 20 U/ml

Dose 0.5 U/kg IV then 0.001 to 0.004 U/kg/min, which is 0.06 to 0.24 U/kg/h. Dilute 0.36 ml of vasopressin in 60 ml of 0.9% NaCl, giving a dilution of 0.12 U/ml. Start CRI at 0.5 ml/kg/h which is a dose of 0.001 U/kg/min. Increase up to 2 ml/kg/h IV, or decrease, as necessary to maintain acceptable ABP.

Epinephrine 1 mg/ml

Dose is 0.1 to 1 mcg/kg/min, which is 0.006 to 0.06 mg/kg/h IV. Dilute 0.72 ml of epinephrine in 60 ml of 0.9% NaCl, giving a dilution of 12 mcg/ml. Start CRI at 0.5 ml/kg/h, which is a dose of 0.1 mcg/kg/min. Increase up to 5 ml/kg/h IV, or decrease, as necessary to maintain acceptable ABP.

Dopamine 40 mg/ml

Dose is 2 to 20 mcg/kg/min, which is 0.12 to 1.2 mg/kg/h IV. Dilute 0.3 ml of dopamine in 60 ml of 0.9% NaCl, giving a dilution of 200 mcg/ml. Start CRI at 1 to 2 ml/kg/h if moderate hypotension, which is 3.3 to 6.6 mcg/kg/min. Start the CRI at 3 to 4 ml/kg/h if severe hypotension, which is 10 to 13.3 mcg/kg/min. Increase up to 6 ml/kg/h if necessary. Reassess arterial blood pressure frequently. Adjust CRI as needed to maintain acceptable ABP.

Dilution Volumes

Amount of drug (ml) to add for CRIs starting at 1 ml/kg/h IV (shake well to mix properly)

Drug

60 ml syringe

150 ml bag

250 ml bag

500 ml bag

Dobutamine

1.5

3.75

6.25

12.5

Phenylephrine

0.36

0.9

1.5

3

Ephedrine

0.36

0.9

1.5

3

Vasopressin

0.36

0.9

1.5

3

Epinephrine

0.72

1.8

3

6

Dopamine

0.3

0.75

1.25

2.5

Norepinephrine

1.45

3.6

6

12

  

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

V. Lukasik, DVM, DACVAA
Southwest Veterinary Anesthesiology
Tucson, AZ, USA


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