Claire Roberts rvn dipavn(Surg) vncertecc aetiology and Patient Presentation of the gdv patient

Induction

Propofol has negative cardiovascular effects which can be detrimental to a critical patient. It causes a decrease in cardiac contractility and an increase peripheral vasodilation both of which result in hypotension. Using a co-induction technique such as a benzodiazipine e.g midazolam alongside propofol can reduce the required dose and minimise the side-effects.

If available a co-induction technique using midazolam and fentanyl is a good combination for compromised patients, both drugs have minimal cardio respiratory depressant effects and are both easily reversed.

Alfaxalone may be a better choice over Propofol due to its ability to maintain heart rate and blood pressure better. Alfaxalone can also be used alongside a benzodiazipine as a co-induction.

The addition of Lidocaine to the induction protocol has many benefits. It is a well know anti-arrhythmic drugs, but also adds to the analgesia.

Canine Induction doses
Propofol	4mg/kg
Alfaxan	2mg/kg
Midazolam	0.2mg/kg
Diazepam	0.5mg/kg
Fentanyl	5mcg/kg
Lidocaine	2mg/kg

During induction the patient should be provided with oxygen and the head held upwards in case of regurgitation, this is especially important in gastric dilation cases. Suction should be set up and close by so that any regurgitation can be quickly dealt with. Ensure that the cuff of the endotracheal tube is properly inflated to prevent and stomach contents from being inhaled.

All induction drugs should be given slowly and too effect. Compromised patients will require much lower dosages to induce anaesthesia. All monitoring should be attached to the patient before induction starts to allow close monitoring throughout.