Guidelines

Guidelines on Anesthesia and Analgesia in Dogs

Unit for Laboratory Animal Medicine
Dec 13, 2013 12:00 am

This document has been designed by the ULAM veterinary staff as a guideline for sedation, anesthesia, and analgesia of laboratory canines. This is not intended to be an inclusive tutorial on all possible drug combinations that can be used in canines. The following guidelines are also general recommendations and consequently do not include reference to specific research associated concerns.

All surgical procedures, anesthetics, analgesics, antibiotics or other medications used on animals must be approved by the IACUC, described in the animal use protocol, performed by personnel listed on the protocol, and appropriately trained for the surgical procedure.  Any techniques or drug protocols deviating from this document must be justified and approved in the IACUC protocol prior to application.

  • Responsibility

    1. Principal Investigator: Responsible to ensure appropriate anesthesia and/or analgesia is provided for all canines undergoing potentially painful procedures, including survival surgery, unless otherwise indicated in the relevant approved protocol.
  • Definitions

    1. Anesthesia: Temporarily induces loss of sensation with or without loss of consciousness.
    2. Analgesia: Provides pain relief without loss of consciousness.
    3. A/A: Anesthesia and analgesia.
    4. CRI: Continuous rate of infusion.
    5. IM: Intramuscular route of administration.
    6. IV: Intravenous route of administration.
    7. SC: Subcutaneous route of administration.
    8. Sedation: A mild degree of central depression in which the patient is awake but calm.
  • Procedures

    1. Prior to Anesthetic/Analgesic/Sedative Event

    1. Handling and Restraint
      1. To avoid excessive anxiety in the pre- and post- anesthetic periods, provide an environment devoid of extraneous noise, including loud talking.
      2. The amount of restraint and its duration should be kept to the minimum required to accomplish the necessary procedure.
      3. To reduce the time of restraint, equipment and reagents should be ready to use prior to handling the animal.
      4. Pre-anesthetic doses of sedative/tranquilizer agents are often used to facilitate immobilization and to reduce anxiety.
    2. Preanesthetic Fasting
      1. Preanesthetic fasting is required to prevent aspiration pneumonia. More information regarding fasting duration can be found in Guidelines on Experimental Food or Water Restriction or Manipulation in Laboratory Animals.
    3. Ocular lubrication such as Paralube® must be used to prevent corneal drying during anesthesia or sedation.

    2. Routes of Administration

    1. More detailed information regarding injection techniques and maximum quantities safely administered to dogs can be found in Guidelines on Administration of Substances to Laboratory Animals.

    3. Normal Monitoring Parameters

    1. More information on anesthetic/sedation monitoring requirements can found in Anesthesia and Sedation Monitoring Guidelines.
    2. The goal of monitoring should be to maintain normal cardiac function, respiratory function, and body temperature. Understanding the basic physiologic effects of the anesthetics used is paramount to correctly interpreting monitoring parameters. More information on anesthetic and sedative effects on physiologic parameters can be found in Anesthesia and Analgesia Drug Descriptions.
      1. Without anesthesia
        1. Temperature = 100 - 102.5 oF; 38 – 39 oC
        2. Heart Rate (beats/min) = 70-180
        3. Respiratory Rate (breaths/min) = 20-40 resting
      2. With anesthesia
        1. Temperature = >98 oF; >37 oC
        2. Heart Rate (beats/min) = 60-80
        3. Respiratory Rate (breaths/min) = 10-12
      3. Pulse: Strong and regular (a lingual-tongue artery can be palpated if necessary)
      4. Blood pressure: Systolic blood pressure >90 mm Hg and mean >70 mm Hg
      5. Capillary refill time: <2s
      6. Mucous membranes: pink not pale, white, or blue

    4. Physiologic Support

    1. Hypothermia
      1. An external heat source should be provided during the entire anesthetic and recovery period. For examples of approved external heat supplementation products, please refer to the Anesthesia and Sedation Monitoring Guidelines.
    2. Fluids
      1. Providing fluid support during anesthesia is important particularly if a procedure lasts one-half hour or more. More information on appropriate fluid rates can be found in Guidelines on the Performance of Surgery in Non-Rodent Mammals.
    3. Vascular Access
      1. The placement of indwelling catheters are advised. Cephalic, lateral saphenous, and jugular veins are readibly accessible in dogs for intravenous administration of drugs and fluids.
    4. Endotracheal Intubation
      1. Dogs are easily intubated with the use of a laryngoscope.
      2. Endotracheal tube sizes for 25-kg dogs are between 7.5 and 9 mm OD; for a 50-kg dog, sizes range from 10 to 15 mm OD. It is important to have several sizes available and ready with appropriate ties when attempting intubation.
      3. Application of sterile surgical lubricant to the tip of the endotrachaal tube will help facilitate intubation. Inflate the cuff just enough to stop gas leakage. Over-inflation of the endotracheal tube cuff can damage the trachea.

    5. Recovery

    1. More information on required monitoring parameters during post-operative recovery can be found in Guidelines on the Performance of Surgery in Non-Rodent Mammals.
    2. Recover animals in clean kennels or transport cages.
      1. Ideally, animals will be recovered in the surgery area so they can be appropriately monitored throughout the post-operative period.
    3. If a large number of surgeries are being conducted at one time, animals may be housed together following anesthesia and prior to full recovery if they are continually observed. This is to ensure that more alert animals do not injure non-responsive cage mates.
    4. Nutritional support should be with-held until the animal is fully recovered and ambulating normally.

    6. Sedation Protocols

    1. Detailed information on all approved anesthetics and sedatives can be found in Anesthesia and Analgesia Drug Descriptions.
    2. All premedicants and sedatives should be administered 15-20 minutes prior to restraint or induction. Duration of action for sedative-analgesic combinations for use in minor procedures is generally 15-60 minutes depending upon combination used.
    3. The following drug combinations are for use with minor procedures or as premedicants prior to anesthetic induction.
      1. For dose ranges listed as IV, IM, and SC, use lower end of the range for IV administration.

           Sedation +/- Analgesia   

           Drug or Combination   

           Dosage   

           Route   

           Mild to moderate sedation   

           Acepromazine   

           0.025 - 0.2 mg/kg   
           0.1 - 0.25 mg/kg   

           IV   
           IM / SC   

         

           Dexmedetomidine   

           2 - 10 µg/kg   

           SQ / IM / IV   

         

           Midazolam   

           0.2 - 0.4 mg/kg   

           IM / IV   

           Mild to moderate sedation   
           Mild analgesia   

           Acepromazine   
           + Butorphanol   

           0.005 - 0.060 mg/kg   
           + 0.1 - 0.4 mg/kg   

           IV / SQ / IM   

         

           Midazolam   
           + Butorphanol   

           0.10 - 0.20 mg/kg   
           + 0.1 - 0.40 mg/kg   

           IM / IV   

           Mild to moderate sedation   
           Moderate analgesia   

           Acepromazine   
           + Buprenorphine a   

           0.025 - 0.10 mg/kg   
           + 0.01 - 0.02 mg/kg   

           SQ / IM / IV   

         

           Midazolam   
           + Buprenorphine a   

           0.10 - 0.20 mg/kg   
           + 0.01 - 0.02 mg/kg   

           SQ / IM / IV   

           Moderate sedation   
           Moderate to strong analgesia   

           Acepromazine   
           + Hydromorphone or   
           Morphine or   
           Oxymorphone or   
           Fentanyl   

           0.010 - 0.060 mg/kg   
           + 0.10 - 0.20 mg/kg or   
           0.50 - 1.0 mg/kg or   
           0.05 - 0.10 mg/kg or   
           0.005 - 0.010 mg/kg   

           SQ / IM / IV   

         

           Midazolam   
           + Hydromorphone or   
           Morphine or   
           Oxymorphone or   
           Fentanyl   

           0.10 - 0.20 mg/kg   
           + 0.10 - 0.20 mg/kg or   
           0.50 - 1.0 mg/kg or   
           0.05 - 0.10 mg/kg or   
           0.005 - 0.010 mg/kg   

           IM / IV   

         

           Dexmedetomidine   
           + Buprenoprhine a   

           2 - 10 µg/kg   
           + 0.01 - 0.02 mg/kg   

           SQ / IM   

           Profound sedation   
           Strong analgesia   

           Dexmedetomidine   
           + Hydromorphone or   
           Morphine or   
           Oxymorphone or   
           Fentanyl   

           2 - 10 µg/kg   
           + 0.10 - 0.20 mg/kg or   
           0.50 - 1.0 mg/kg or   
           0.05 - 0.10 mg/kg or   
           0.005 - 0.010 mg/kg   

           IM / IV   

         

           Tiletamine + Zolazepam (Telazol®)   

           6 - 13 mg/kg   

           SQ / IM   

         Preemptive analgesia, particularly opiates like buprenorphine, can reduce the dose of anesthetics required for surgical anesthesia and increase the respiratory depression associated with anesthetics. When pre-emptive analgesia is used, consider reducing the dose of anesthetic (whether inhalant or injectable) to the low end of the recommended range. Anesthetic depth must be carefully monitored and drug doses may need to be titrated to maintain appropriate levels. With new projects, sexes, strains or anesthetic analgesic combinations, assess a subset of animals before expanding to use in a larger cohort. 

    7. Anesthetic Protocols

    1. For dose ranges listed as IV, IM, and SC, use lower end of the range for IV administration.
    2. Anticholinergics
      1. Atropine 0.02-0.04 mg/kg SC, IM, or IV
      2. Glycopyrrolate 0.01 - 0.02 mg/kg SC or IM
    3. Injectable Anesthestic Induction Agents Used in Dogs

        Drug   

         Dose and Route   

         Notes   

         Ketamine   
         + Midazolam   
         5 mg/kg (K)   
         + 0.28 mg/kg (M) IV or IM   
      • May be mixed in same syringe.   
      • Ketamine may sting with IM application.   
      • For IV administration, administer midazolam first, then titrate ketamine to effect.   
      • Average duration 10 - 20 minutes.   
         Ketamine   
         + Diazepam   
         5 mg/kg (K) IV or IM   
         + 0.25 mg/kg (D) IV   
      • Diazepam can only be given IV.   
      • Ketamine can be given IM or IV (stinging may occur IM).   
      • For IV administration, administer diazepam first, then titrate ketamine to effect.   
      • Average duration 10 - 20 minutes.   
         Ketamine   
         + Dexmedetomidine   
         + Opioid   
         "Doggie Magic"   
         1 - 3 mg/kg (K)   
         + 2 - 10 µg/kg (D)   
         + an opioid such as   
         butorphanol 0.1 - 0.2 mg/kg or   
         buprenorphine 0.005 - 0.01 mg/kg or   
         hydromorphone 0.05 - 0.2 mg/kg   
         IV or IM   
      • Provides anesthesia AND analgesia.   
      • May be combined into same syringe.   
      • Dexmedetomidine cannot be used in dogs < 2 kg.   
      • Peak sedation 20 - 30 minutes after administration.   
         Pentobarbital   
         10-30 mg/kg IV to effect   
      • Apnea or decreased breathing especially with higher and repeat doses.   
      • Recovery time is prolonged with this agent.   
      • Single dose duration 10 - 45 minutes.   
         Tiletamine + Zolazepam   
         (Telazol®)   
         2 mg/kg IV or   
         5 mg/kg IM   
      • Good for fractious dogs, but rough recovery.   
      • Average duration 10 - 30 minutes.   
         Propofol   
         4 - 6 mg/kg IV in unmedicated animals   
         1 - 4 mg/kg IV in premedicated/sedated animals   
      • Deliver titrated volume over a couple of minutes as rapid administration will lead to apnea and hypotension.   
      • Very rapid onset and recovery.   
      • CRI may be used for anesthetic maintenance (see below).   
    1. Anesthetic Maintenance Protocols
      1. Inhalation Agents

           Drug   

           Dose   

           Notes   

           Isoflurane   

           4 - 5% induction   
           1 - 2% maintenance   

        • Requires use of calibrated vaporizer specific to isoflurane   

           Sevoflurane   

           7 - 9% induction   
           3 - 5% maintenance   

        • Requires use of calibrated vaporizer specific to sevoflurane   

         

    1. Total Intravenous Anesthesia (TIVA) Maintenance

         Drug   

         Dose   

         Notes   

         Propofol CRI   

         0.5 - 0.4 mg/kg/min   

      • Begin CRI after initial induction dose.               

         Morphine   
         + Lidocain   
         + Ketamine   
         CRI   

         0.10 (M) mL/kg/h   
         + 0.10 (L) mL/kg/h
         + 0.10 (K) mL/kg/h

      • Dilute 60 mg Morphine + 500 mg Lidocaine + 60 mg Ketamine in a 500 mL bag LRS.   
      • Deliver @ 1 mL/kg/hr
      • Mixture is light sensitive.   
      • Protect from light for prolonged use.   
      • Initial loading doses as follows:
        • (M) 0.5 mg/kg IM or very slow IV
        • (L) 0.5 - 1.0 mg/kg IV   
        • (K) 0.25 - 0.50 mg/kg IV   

    8. Neuromuscular Blocking Agents (NMBA)

    1. Extreme care must be taken to ensure that a proper level of anesthesia and analgesia is achieved prior to administering a neuromuscular blocking agent.
    2. Neuromuscular blocking agents require special monitoring procedures which are detailed in Anesthesia and Sedation Monitoring Guidelines.
      1. Concurrent positive pressure ventilation is required.

           Drug   

           Dose and Route   

           Duration of Effect   

           Notes   

           Atracurium besylate   
           0.10 - 0.40 mg/kg IV or   
           0.2 - 0.5 mg/kg IV loading dose   
           followed 5 min later by CRI of   
           3.0 - 9.0 µg/kg/min.   
           20 - 40 minutes   
        • Do not dose more than every 20-30 minutes unless peripheral nerve stimulator is applied or voluntary movement is observed.
        • Dilute in D5W or 0.9% NaCl.   
        • Do NOT mix with other drugs.   
            Vecuronium bromide   
           0.10 mg/kg IV or   
           0.10 - 0.20 mg/kg/hr   
           25 minutes   
        • Subsequent doses of 0.04 mg/kg IV may be administered.           
           Pancuronium bromide   
           0.05 - 0.1 mg/kg IV   
           45 - 60 minutes   
        • Duration is dose dependant.   
        • Higher dose administered initially with lower doses repeated if needed.

         

    9. Local Anesthetics

    1. Appropriate for minimally invasive procedures such as skin biopsy, or as a supplement to sedation, anesthesia and analgesia.
      1. Local anesthetics are excellent analgesics for use in minor procedures or as "splash blocks" for post-operative incision pain.

           Drug   

           Dose and Route   

           Duration of Effect   

           Notes   

           Lidocaine 1 - 2%   
           1.0 - 2.0 mg/kg   
           SQ infiltration or   
           local nerve block   
           5 - 10 minutes to onset   
           1 - 2 hours duration   
        • Addition of 1ml of 8.4% sodium bicarbonate / 10ml lidocaine reduces discomfort of injection.   
        • Potential for CNS toxicity manifesting as seizures.   
           Bupivacaine 0.25 - 0.5%   
           1.0 - 2.0 mg/kg   
           SQ infiltration or   
           local nerve block   
           20 - 30 minutes to onset   
           3 - 5 hours duration   
        • Never give IV (Cardiotoxic if given IV)   
        • DO NOT exceed maximum dose and ALWAYS aspirate prior to injection to guard against inadvertent IV administration.   
        • Can be diluted with saline to increase volume   
           Combination Lidocaine 2% &   
           Bupivicaine 0.5%   
           1 mg each   
           Quick onset of lidocaine with   
           prolonged duration of bupivicaine   

                                                                                                                       

           Addition of 1:200,000 epinephrine   
           delays absorption and prolongs   
           local anesthesia   
           
           
           

         

    10. Analgesics

    1. Canine signs of pain include but are not limited to the following:
      1. Reluctance to move
      2. Quiet
      3. Unalert
      4. Hunched appearance
      5. Abnormal posturing
      6. Increased respiration
      7. Unprovoked growling
      8. Decreased appetite
      9. Social isolation
      10. Abnormal aggression
      11. Guarding of painful area
      12. Lick / scratch painful area
      13. Restlessness
    2. Preferred opioid analgesics are buprenorphine, hydromorphone, or morphine.
      1. Buprenorphine and other narcotic agonists can be completely reversed with naloxone.
    3. The preferred non-steroidal anti-inflammatory (NSAID) is carprofen because it is generally well tolerated by the gastrointestinal tract, has good duration of effect, and does not appear to adversely affect platelet function.
    4. Opioids and NSAIDs can be combined for their additive or synergistic analgesic effects.

         Drug   

         Dose and Route   

         Duration of Effect   

         Notes   

         Opioids   

       

       

       

         Buprenorphine   
         (Buprenex®)   
         0.005 - 0.02 mg/kg   
         IV, IM, SQ   
         6 - 8 hours   
      • Good analgesic.   

         Hydromorphone   
         0.05 - 0.2 mg/kg   
         IV, IM, SQ   
         4 hours   
      • Occasional vomiting and panting.   
      • Good analgesic.   
         Morphine   
         0.25 - 2.0 mg/kg   
         IM, SQ   
         4 hours   
      • Frequent vomiting and panting.   
      • Doses exceeding 1 mg/kg may result in constipation.   
      • Good analgesic.   
         Oxymorphone   
         0.05 - 0.10 mg/kg   
         IV, IM, SQ   
         3 - 4 hours   
      • Less vomiting than with hydromorphone and morphine.   

         Fentanyl Infusion   
         10 - 30 µg/kg/hr IV intra-op   
         1 - 5 µg/kg/hr IV post-op   
         2 - 3 µg/kg loading dose   
         CRI Bolus: 10 - 30 minutes   
      • Decreased heart rate and respiratory depression during surgery.   

         Fentanyl patch   
         (Duragesic®)   
         50 µg/hour patch (10 - 20 kg) transdermally   
         75 µg/hr patch (20 - 30 kg)   
         1 - 3 days   
      • Requires up to 24 hours to take effect, avoid concurrent opioids.   

         Tramadol   
         2 - 5 mg/kg   
         PO   
         6 - 8 hours   
      • Dosing four times a day is recommended.   

         NSAIDs   

       

       

       

         Carprofen   
         (Rimadyl®)   
         2.2 mg/kg PO (1.0 mg/lbs)   
         4.4 mg/kg PO or SQ   
         12 hours   
         24 hours   
      • NSAID   
      • Recommended for use with musculosckeletal pain.   
         Ketoprofen   
         2 mg/kg   
         SQ, IM   
         24 hours   
      • Recommended not to exceed 3 days duration due to possible GI side effects.   

         Etodolac   
         (EtoGesic®)   
         10 - 15 mg/kg   
         PO   
         24 hours   
      • Can not be accurately dosed in dogs less than 5 kg.   

         Meloxicam   
         0.2 mg/kg PO, IV or SC for the first day,   
         followed by 0.1 mg/kg PO once daily   
         24 hours   
         
         Deracoxib   
         (Deramaxx®)   
         1 - 2 mg/kg PO for osteoarthritis pain   
         3 - 4 mg/kg PO for post-operative pain   
         24 hours   
      • Recommended not to exceed 7 days duration due to possible GI side effects.   

       

  • Related Documents

  • References

    1. Flecknell, P. (2009) Laboratory Animal Anesthesia, Third Edition, Academic Press, Ltd., London.
    2. Plumb, DC. (2011) Veterinary Drug Handbook. PharmaVet Inc, Stockholm, Wisconsin.
    3. Thurmon, JC, Tranquilli, WJ, & Benson, GJ eds. (1996). In Lumb and Jones' Veterinary Anesthesia, 3rd ed. Williams and Wilkins, Baltimore, Maryland.
    4. The Veterinary Anesthesia & Analgesia Support Group (www.vasg.org)
    5. Hawk et al. (2005) Formulary for Laboratory Animals. Blackwell Publishing, Ames, Iowa.
    6. Giuliano EA. Regional Anesthesia as an Adjunct to Lid Surgery (PT50). Western Veterinary Conference 2006.
Species: Dogs
Questions?

If you have questions or comments about this document, contact ULAM Veterinary Staff (ULAM-vets@umich.edu or 734-936-1696).

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For any concerns regarding animal health after work hours or on holidays/weekends, contact DPS (3-1131) who will contact the on-call veterinarian.