Anesthesiology & Pain Management

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In the last 10 years, the veterinary profession has undergone what can only be described as a sea change in perspectives about animal pain and pain control. A 1993 evaluation of a veterinary teaching hospital surgical caseload revealed only 40% of patients that had undergone highly invasive, painful procedures (including orthopedic repair, thoracotomy, and intervertebral disc decompression) received any sort of pain control, and then only based on clinical signs.

Our patient population has changed fairly dramatically in the last 10 years as our medical skills have progressed and we have become capable of supporting patients with advanced disease and advancing age. Now we must hone our anesthesia skills in order to support patients that largely don't fit into the 'young, healthy' category and it is no longer appropriate to think that safe anesthesia means recovering as many patients as we anesthetize.

Anesthesia should be thought of as 4 distinct and equally important periods: 1) preparation/premedication; 2) induction; 3) maintenance and 4) recovery. We tend to diminish the importance of the phases of preparation/premedication and recovery and yet these phases contribute as much to successful anesthesia as the phases of induction and maintenance.

The most effective way to deal with anesthetic emergencies is to prevent them and appropriate 1) stabilization of the patient, 2) selection of type and dosage of anesthetic drugs, 3) preparation of anesthetic equipment, 4) pre-, post- and intra-operative support of the patient, and 4) physiologic monitoring, will make the anesthetic episode safer and will decrease the likelihood of anesthetic emergencies.

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Regional or local anesthesia of the equine head greatly facilitates performing standing procedures that are anticipated to elicit pain in the patient. With effective local anesthesia, less systemic sedatives may be required for standing surgeries (e.g. dental extractions, laceration repairs, incisor avulsion repairs), patients under general anesthesia can be run at a lighter plane of anesthesia, and postoperative pain may be lessened if effective preemptive analgesia is in place.

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The overall goal of anesthesia is survival and optimum recovery from surgery. In order to accomplish this goal, the surgery patient must be continually monitored for changes, especially deterioration in respiration, cardiac function and tissue perfusion regardless of the specific surgery.