--- 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`. --- Source attribution: OpenVet-Projects Original project: https://github.com/OpenVet-Projects/VetClaw/blob/a989b1cbf93c703bb95974616c4285c5e2098b3f/skills/clinical/anesthesia-protocols/SKILL.md License: MIT License information: https://opensource.org/license/mit Original upstream instructions; downloaded from Mega AI Hub. ## Upstream license notice MIT License Copyright (c) 2026 OpenVet AI (openvet.ai) Permission is hereby granted, free of charge, to any person obtaining a copy of this software and associated documentation files (the "Software"), to deal in the Software without restriction, including without limitation the rights to use, copy, modify, merge, publish, distribute, sublicense, and/or sell copies of the Software, and to permit persons to whom the Software is furnished to do so, subject to the following conditions: The above copyright notice and this permission notice shall be included in all copies or substantial portions of the Software. THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM, OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE. # Mega AI Hub resource metadata Creator / publisher: OpenVet-Projects Original project: https://github.com/OpenVet-Projects/VetClaw/blob/a989b1cbf93c703bb95974616c4285c5e2098b3f/skills/clinical/anesthesia-protocols/SKILL.md Attribution basis: Source repository record Fields of work: Education & Research, Healthcare & Life Sciences Roles: Clinical Research, Medical Writer, Tutor / Instructor Specialties: Specialty not specified Tools: Tool not specified Country applicability: Country not specified Classification basis: Source catalog labels Instruction SHA-256: 589225ca6164f4fef27be9bf547e40f30d6f35e636dc738a65a5253f91bb00fe