anesthesia-protocols

name	anesthesia-protocols
description	Species-specific anesthesia protocols including premedication, induction, maintenance, and monitoring. Accounts for brachycephalic risk, sighthound sensitivity, ASA classification, and common anesthetic emergencies.

Anesthesia Protocols

Overview

Species-specific anesthesia protocols including premedication, induction, maintenance, and monitoring. This skill covers the practical protocol selection — for safety monitoring, emergency management, and breed-specific risk assessment, see the companion skill anesthesia-safety.

When to Use

• User needs an anesthesia protocol for a specific species and procedure
• User asks about drug selection for premedication, induction, or maintenance
• User asks about species-specific anesthetic considerations
• Keywords: anesthesia, sedation, premedication, induction, intubation, isoflurane, sevoflurane, propofol, alfaxalone, dexmedetomidine, ASA, monitoring

Standard Canine Protocol

Phase	Drug Options	Dose Range	Notes
Premedication	Dexmedetomidine + Hydromorphone	5-20 mcg/kg IM + 0.1 mg/kg IM	Adjust for ASA status; reduce for debilitated patients
Premedication (alt)	Acepromazine + Butorphanol	0.01-0.05 mg/kg IM + 0.2-0.4 mg/kg IM	Avoid ace in Boxers, MDR1 breeds
Induction	Propofol	2-6 mg/kg IV to effect	Titrate slowly; apnea risk at higher doses
Induction (alt)	Alfaxalone	1-3 mg/kg IV to effect	Good for cardiovascular compromise
Maintenance	Isoflurane or Sevoflurane	MAC: iso 1.3%, sevo 2.3%	Sevoflurane: faster induction/recovery, more expensive
Analgesia	Fentanyl CRI	2-5 mcg/kg/hr IV	Reduces MAC by 30-50%; manage bradycardia

Standard Feline Protocol

Phase	Drug Options	Dose Range	Notes
Premedication	Dexmedetomidine + Buprenorphine	10-40 mcg/kg IM + 0.02 mg/kg IM	Can combine in same syringe (IM kitty magic)
Premedication (alt)	Alfaxalone + Butorphanol	2 mg/kg IM + 0.3 mg/kg IM	Good for fractious cats
Induction	Propofol	2-6 mg/kg IV to effect	Cats: Heinz body anemia with repeat dosing (avoid CRI)
Induction (alt)	Alfaxalone	1-3 mg/kg IV to effect	Preferred for cats needing repeated anesthesia
Maintenance	Isoflurane or Sevoflurane	MAC: iso 1.6%, sevo 2.6%	Higher MAC than dogs

Equine Protocol (Standing Sedation)

Drug	Dose	Route	Duration
Xylazine	0.5-1.1 mg/kg	IV	20-30 min
Detomidine	10-40 mcg/kg	IV	30-90 min
Butorphanol	0.01-0.04 mg/kg	IV	Combine with alpha-2 for neuroleptanalgesia

Equine Protocol (General Anesthesia)

Phase	Drug	Dose	Notes
Premedication	Xylazine or Detomidine	As above	Wait for full sedation before induction
Induction	Ketamine + Diazepam	2.2 mg/kg + 0.05 mg/kg IV	Administer rapidly as bolus
Maintenance	Isoflurane (Triple Drip alternative)	MAC 1.3% (or ketamine/xylazine/GGE CRI)	Equine anesthesia carries ~1% mortality risk (10x higher than small animal)
Recovery	Quiet, padded recovery stall	Assisted vs. unassisted	Most critical phase; myopathy and fracture risk

Breed-Specific Safety Alerts

• Boxers: Acepromazine sensitivity — risk of profound, prolonged hypotension. Use alternative sedation (dexmedetomidine, butorphanol).
• Sighthounds (Greyhounds, Whippets, etc.): Prolonged recovery from thiopental and propofol due to low body fat. Dose-reduce propofol. Alfaxalone may be preferred.
• MDR1-Mutant Breeds (Collies, Aussies, Shelties, etc.): Exercise caution with acepromazine, butorphanol, and other P-glycoprotein substrates. Dose-reduce by 25-50% or substitute. Test MDR1 status when possible.
• Brachycephalics (Bulldogs, Pugs, Persians): High risk for upper-airway obstruction. Pre-oxygenate, have multiple endotracheal tube sizes ready, avoid heavy sedation, and delay extubation until strong swallow reflex.
• Giant breeds (Great Dane, Mastiff, Irish Wolfhound): Higher sensitivity to alpha-2 agonists. Increased bloat/GDV risk perioperatively. Position carefully to prevent myopathy/neuropathy.
• Pediatric (<12 weeks): Immature hepatic metabolism, limited glycogen reserves (hypoglycemia risk), higher body surface area (hypothermia risk). Reduce drug doses, minimize fasting, maintain body temperature aggressively.
• Geriatric: Reduced hepatic/renal clearance, cardiac reserve. Pre-anesthetic bloodwork mandatory. Reduce doses 25-50%.

Key Species Differences

Parameter	Dog	Cat	Horse
Mortality risk	~0.1%	~0.2%	~1%
Propofol CRI	Acceptable	Avoid (Heinz bodies)	Not used
Alpha-2 reversal	Atipamezole	Atipamezole	Atipamezole (caution)
Intubation	Straightforward	Laryngospasm common; use lidocaine spray	Blind nasal or oral
Common emergency	Hypotension	Hypothermia, bradycardia	Myopathy, recovery fractures

Workflow

1. Confirm species, breed, age, weight, and ASA status (MANDATORY).
2. Review pre-anesthetic bloodwork (CBC, chemistry, coagulation if indicated).
3. Select premedication based on species, temperament, and procedure. Account for breed-specific contraindications.
4. Select induction agent and calculate dose. Titrate to effect.
5. Intubate and maintain on inhalant or injectable protocol. Monitor continuously (SpO2, ETCO2, ECG, BP, temperature).
6. Manage analgesia throughout: multimodal approach (opioid + NSAID + local block where possible).
7. Recovery monitoring until patient is extubated, normothermic, and ambulatory.

Limitations

• Anesthetic protocols must be individualized based on patient assessment; no single protocol suits all cases.
• Drug availability varies by country and institution. Not all agents are licensed in all jurisdictions.
• Equine anesthesia carries inherently higher risk than small animal; specialist involvement is recommended for complex cases.
• Dosing information is for reference only; always verify against current formulary (Plumb's) and patient-specific factors.
• This skill covers protocol selection. For safety monitoring, emergency management, and breed risk details, see anesthesia-safety.