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Preanesthetic Considerations

HuiChu Lin

Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, USA

General anesthesia in farm animals, like cattle, sheep, goats, llamas, alpacas, and pigs, requires special attention due to the uniqueness of the anatomical and physiological characteristics as compared to dogs, cats, and horses. Camelids (llamas and alpacas) only have two forestomachs but are otherwise similar in many ways to cattle and small ruminants. Although some farm animals may cost as much as purebred companion animals, farm animal veterinarians are often faced with economic constraints and a limited number of approved drugs for use in surgical procedures requiring anesthesia. Physical restraint and local anesthetic techniques are most commonly employed to produce immobility and analgesia for these species. Ruminants generally tolerate physical restraint and recumbency well. This, along with local and/or regional anesthetic techniques, allows many minor surgical procedures to be performed in the standing position and under field conditions. General anesthesia is more frequently performed in camelids and swine for even minor surgical procedures due to their intolerance of physical restraint. It is important to remember that farm animals perceive pain no differently than other species, therefore analgesia for prevention and easing of pain is just as important as it is for companion animals. With surgical procedures requiring general anesthesia, balanced anesthetic technique should be employed to provide narcosis, analgesia, and muscle relaxation, thereby minimizing the stress response induced by surgery and anesthesia. Most of the anesthetics and anesthetic adjuncts commonly used in farm animal practice do not have Food and Drug Administration (FDA) approval for use in ruminants, camelids, and swine [1, 2]. However, per the Animal Medicinal Drug Use Clarification Act (AMDUCA) of 1994, extralabel use of drugs is permitted when animal health is threatened or death may result if not treated [3]. While prevention of violative residues should always be considered, anesthetics are usually used for a short duration, and anesthetized animals are unlikely to be marketed immediately after surgery. Furthermore, anesthetics used today tend to have very short half-lives (t½), and they are potent enough that only low doses are required to produce general anesthesia. The possibility of an animal carrying anesthetic residues within its edible tissues after the surgical incision has healed, which normally occurs within an average of 14?days, is extremely low. Thus, problems with anesthetic drug residues appear to be rare [4]. Nevertheless, veterinarians should consult the Food Animal Residue Avoidance Databank (FARAD) for meat and milk withdrawal intervals for extralabel use of analgesics, sedatives, and injectable anesthetics as well as for updates of drugs prohibited from extralabel use [1, 2].

Prior to anesthesia, an appropriate patient history, including breed, age, sex, condition, and temperament of the patient, and a complete physical examination are indicated. Due to economic reasons, blood work including complete blood count and chemistry profile is performed only in farm animals with significant systemic diseases and those considered to have a higher anesthetic risk. For example, animals with severe gastrointestinal (GI) abnormalities often suffer extreme dehydration with or without electrolyte alteration, which may require intervention to optimize the patient's condition with fluid therapy prior to the induction of anesthesia [5]. In healthy animals, total plasma protein and packed cell volume are sufficient indicators of a patient's hydration status.

Most sedatives and general anesthetics cause some degree of cardiovascular depression, which may not be a great concern for healthy patients. However, normal cardiovascular protective mechanisms or reflexes in response to the depressing effects of anesthetics may be obtunded in animals with compromised cardiac function or severe electrolyte imbalances as a consequence of disease conditions. Maintaining a balance of concentrations of electrolytes like calcium, sodium, and potassium across the cell membranes is essential in establishing normal cell membrane potential and contractility. Disturbance of these electrolyte balances across cell membranes changes cellular resting membrane potentials and subsequent initiation and propagation of cellular depolarization and repolarization. Acidosis has been shown to cause electrolyte imbalances resulting in decreased myocardial contractility and increased response of the myocardial cells to circulating catecholamines. Therefore, anesthetic-induced cardiovascular depression combined with severe preexisting acidosis and electrolyte imbalances can lead to detrimental side effects like severe cardiac arrhythmias, bradycardia, decreased myocardial and vascular cellular contractility, reduced cardiac output, and hypotension. As a result, anesthetized animals may not be able to maintain adequate cardiac output or arterial blood pressure leading to significantly decreased peripheral tissue and muscle perfusion with subsequent development of severe adverse effects such as irreversible postanesthetic neuromyopathy [6].

1.1 Positioning

Ruminants, camelids, and swine are susceptible to complications associated with anesthesia and recumbency. Positioning of these animals, particularly adult cattle, in dorsal or lateral recumbency for surgery allows for the weight of abdominal viscera to shift ventrally and cranially, causing the diaphragm to be pushed further into the thoracic cavity, thereby reducing the functional residual capacity of the lungs (Figure 1.1). As a result, an increased ventilation/perfusion mismatch may lead to significant hypoventilation and hypoxemia during anesthesia. Furthermore, the weight of the abdominal viscera may compress great vessels such as the vena cava leading to decreased venous return, cardiac output, and arterial blood pressures [7]. Therefore, close monitoring of cardiovascular and pulmonary functions and institution of appropriate treatments to ensure normal arterial blood pressure and adequate ventilation are important parts of perioperative anesthetic management.

Figure 1.1 The effect of lateral recumbency on the position of the diaphragm in ruminants: A, rumen; B, diaphragm; C, lungs.

Source: Illustration by Kim Crosslin.

1.2 Ruminal Tympany

Ruminal tympany, bloat, regurgitation, and aspiration pneumonia are common problems associated with general anesthesia in farm animal species that should be anticipated and addressed with proper precautions. Ruminal fermentation continues even in anesthetized animals. Postprandial gas production at an average of 30?l per hour has been reported in cattle [8]. Normal, awake animals are able to relieve the gas produced by fermentation through the eructation. Sedatives and anesthetics tend to inhibit GI motility and prohibit eructation, thus allowing gas to accumulate in the rumen. The rumen of an adult large ruminant has a capacity of 115-150?l [9]. An average capacity of 15-18?l has been reported in small ruminants [10]. Bloating, especially in nonfasted animals, can occur during anesthesia and compromise the cardiopulmonary systems by increasing intra-abdominal pressure resulting in compression of the diaphragm and great vessels such as the vena cava in the abdominal cavity, thus further complicating the already compromised cardiopulmonary function resulting from abnormal positioning required by the surgery. Fasting of these animals prior to anesthesia reduces the amount of gas produced by fermentation and minimizes its detrimental effect on the cardiopulmonary systems.

1.3 Regurgitation

Regurgitation and aspiration of stomach content can occur in farm animal species during anesthesia, especially in nonfasted animals. The risk of regurgitation decreases significantly when water is withheld for 6-12?hours and feed is withheld for 12-24?hours prior to anesthesia in small ruminants. Pigs are monogastrics. It has been indicated that alfalfa or any type of hay delays gastric emptying time, and vomiting with possible aspiration may occur during induction of anesthesia after a recommended fasting period of 12?hours. Thus, removal of alfalfa or other types of hay from their routine diet should be instituted 2-3?days prior to anesthesia [11].

Domestic ruminants have a large rumen that is usually full of liquid materials, and it does not empty completely even after 24-48?hours of fasting. Regurgitation can occur either during light (active regurgitation) or deep (passive regurgitation) anesthesia in ruminants and camelids in spite of preoperative fasting and withholding of water. Active regurgitation usually occurs during light anesthesia and is characterized by explosive discharge of large quantities of ruminal materials. Passive regurgitation occurs during deeper planes of anesthesia when the esophageal muscles and transluminal pressure gradients relax as a result of anesthetic-induced muscle relaxation. If the airway is not protected, a large amount of ruminal materials can be aspirated into the trachea and reach the small...