CHAPTER 18

Zoonoses
Zoonoses are infections or parasitic diseases that can be transmitted between humans and animals. It is beyond
the scope of this chapter to address all of the known zoonoses, but descriptions of many important or
commonly encountered diseases are presented. Any ill or infected animal represents a potential source of
zoonotic infection, but with the use of proper precautions the chances of disease transmission can be greatly
reduced. People who are immunocompromised (e.g., the very young, the aged, those on chemotherapeutic
regimens), have had their spleen removed, or are immunodeficient should avoid contact with sick animals,
because most pathogenic organisms can set up shop in atypical host species if an individual has greatly
lowered (or absent) body defenses.
The practice of epidemiology analyzes factors that influence the incidence, distribution, and control of
infectious disease. By understanding how to recognize the symptoms, transmission, diagnosis, treatment, and
control of transmittable diseases, the incidence of serious illness in humans and animals can be reduced
(Tables 18-1 to 18-6).

TABLE 18-1
Bacterial Zoonoses

Symptoms: Symptoms: Transmissio

Cause Diagnosis Treatment Prevention Control
Human Animal n

Avian Chlamydiosis (Psittacosis, Parrot Fever, Ornithosis)

Chlamydia Severity Acute or Fecal-oral Cloacal/fecal Antibiotic Quarantine/detecti

psittaci; ranges latent route; culture (AB) on/treatment
susceptible from carriers inhalati and therapy of infected
species: mild, (intermitt on/inge isolation, animals;
primary flulike ently stion of serological appropriate
reservoirs illness to shedding infected testing use of PPE
are birds death; infective aerosoli (collected and standard
(common may organism zed 2 wk medical
in include: s); stress fecal apart) precautions;
psittacines, flulike induces matter dampen cage
pigeons, sympto disease/s floor before
sea/shore ms, hedding; cleaning (to
birds, pneumo may reduce
poultry, nitis, include: aerosolization)
waterfowl) pneumo depressio
nia, n,
myocardi anorexia,
tis, ocular/n
encephal asal
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

itis, discharge
thrombo ,
phlebitis dyspnea,
diarrhea
(green)

Bacillus anthracis

Bacillus Three clinical Three clinical Direct Culture/isolati Human: AB Vaccines available
anthracis; presentat presentat contact on, therapy for humans
susceptible ions: ions: with microscop Animal: and animals;
species: all cutaneou peracute, infected ic AB disinfection/st
mammals, s, acute, animal identificati therapy erilization of
most birds intestinal subacute or on (effectiv animal
, /chronic animal e early products;
pulmona product in appropriate
ry; s, insect disease) use of PPE
dissemin vectors and standard
ated and medical
septicem possibly precautions;
ia contami do not
and/or nated perform
meningit water necropsy on
is may sources suspected
occur; cases;
dissemin incinerate or
ated bury deeply
septicem and cover
ia is carcass with
rapidly quicklime
fatal if
untreate
d

Brucellosis (Bangs Disease, Undulant Fever)

Brucella spp.; Clinical Varied, may Direct Culture/isolati AB therapy Test/slaughter;

 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

susceptible presentat include contact on, serum vaccinate cows

species: ion, from abortion, with agglutinati and calves;
most latent to retained infected on, ELISA, appropriate
mammals; chronic, placenta, animals CF (most use of PPE
common may mastitis, or reliable) and standard
in cattle, include: fistulous animal medical
dogs flulike withers, product precautions;
sympto arthritis, s; good
ms, orchitis, humans sanitation/hyg
fatigue, lymphad are iene; proper
weight enopathy always food handling
loss, , sterility accident
depressi al hosts
on,
meningit
is,
encephal
itis,
endocar
ditis;
common
in
vocation
ally
high-risk
persons

Campylobacteriosis (Vibriosis)

Campylobacter May include: May include: Fecal-oral Culture/isolati AB therapy Primarily good
spp.; abdomin 3-7 days contact, on, does not sanitation/hyg
susceptible al pain, of contami cytological shorten iene,
species: acute watery, nated examinati clinical especially
most (possibly mucoid, water, on of feces course when
species, bloody) or infected of handling/
common diarrhea bloody food disease, preparing raw
in birds for 3-5 diarrhea; product but food items
days; anorexia; s eliminat such as
spontane abortions (animal es chicken;
ous ; and carrier appropriate
recovery spontane vegetabl state use of PPE
is ous and Standard
common; recovery Medical
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

without with or e) Precautions

AB without
therapy AB
latent therapy;
carriers may
may become
result latent
carriers

Capnocytophaga canimorsus Infections

Capnocytophaga Can be No signs in Directly or Clinical AB therapy Prevention of bites

canimorsus asympto animals; indirectl presentati (usually and scratches,
; matic or C. y on/appro penicilli thorough
susceptible self- canimors transmi priate n) cleaning/irrig
species: limiting, us may tted by history, ation of all
primarily but may be a domesti culture/is bites,
dogs and manifest commens c dogs olation, immediate
cats as al through serology, medical
nonspeci organism bites or cytological attention if
fic febrile in dogs scratche identificati fever or
illness and cats s; on cellulitis
that domesti develops
frequentl c cats
y have
progress also
es to a been
severe indicate
septicem d in
ia; DIC, transmi
cellulitis, ssion
endocar
ditis,
renal
failure,
and
gangrene
may
occur
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

Cat Scratch Disease (Cat Scratch Fever)

Multiple Primarily in Cats display Directly or Clinical Usually self- Declaw young cats;
bacterial children few if indirectl presentati resolvin owners should
species < 12 any y on/appro g but not allow cats
have been yr; may clinical transmi priate may to lick their
implicated include signs; tted by history, require (owners)
; examples: identifia endocard domesti primary AB open wounds;
Afipia felis, ble itis, c cats inoculator therapy good
Bartonella primary usually (bacilli y lesion, sanitation/hyg
henselae, inoculato self- may be positive iene; handle
Pasteurella ry lesion, limiting normal Hangar- cats gently to
multocida; regional with no oral Rose skin prevent
susceptible lymphad recurrenc flora, test, bites/scratche
species: enopathy e in transmi culture/is s
primarily , flulike recovere tted to olation
cats sympto d claws
ms, patients during
anorexia, groomi
osteolyti ng),
c lesions, usually
oculogla transmi
ndular tted
syndrom through
e bite/scr
atch
Most
commo
nly
from
male,
intact
cats
(< 1
yr),
with
fleas,
not
declawe
d, and
indoor/
outdoor
access
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

Erysipelothrix Infection

Erysipelothrix Cutaneous Acute, Occupationa Culture/isolati AB therapy Good

rhusiopathi infection subacute, l on sanitation/hyg
ae; known or exposur iene;
susceptible as chronic; e via appropriate
species: erysipelo septicemi scratche use of PPE
pigs, wild id on a; raised, s, and standard
and fingers reddish abrasio medical
domestic and purple, ns, or precautions
fowl hands; rhomboi punctur
raised dal e
lesions lesions wounds
accompa (diamon
nied by d skin
severe disease)
pain and Chronic:
swelling may
cause
arthritis,
endocard
itis, and
death

Leptospirosis (Weils disease, Fort Bragg fever)

Leptospira spp.; Incubation 1- Three clinical Contact with Culture/isolati AB therapy: Appropriate use of
susceptible 2 wk, presentat infectiv on (blood, treatme PPE and
species: duration ions: e urine, urine), nt or standard
wide 1-7 days; acute contami microaggl prophyl medical
variety may hemorrh nated utination actic precautions;
mammals include agic, water/s and rodent control;
/reptiles, flulike subacute, oil, macroaggl good
but sympto subclinic direct utination, sanitation/hyg
rodents ms, al; contact ELISA iene, avoid
are a jaundice, acute/su with contaminated
primary anuria, bacute infected water sources,
reservoir rash, may animals vaccination
conjuncti include: (moderately
vitis, high
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

liver/kid fever, effective)

ney septicemi
failure, a,
death anorexia,
depressio
n,
icterus,
hemolyti
c anemia,
endotoxe
mia,
abortion,
mastitis,
infertility

Listerosis

Listeria spp.; Several May include Exposure to Culture/ AB therapy Good

susceptible clinical diarrhea, infected isolation sanitation/hyg
species: presentat flulike animal/ iene,
many ions: symptom birds appropriate
mammals, depends s, product use of PPE
fowl, fish on route excessive s, and standard
(common of salivatio contami medical
in infection; n, nated precautions
ruminants) may mastitis, silage/v
include: monocyt egetable
dermal osis, s
lesions, septicemi
enteritis, a,
septicem purulent
ia, /necrotic
encephal lesions of
itis, visceral
abortion organs/l
/stillbirt ymph
h, birth nodes,
of abortion
infected /stillbirt
neonates h,
encephali
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

tis

Plague

Yersinia spp.; Three main May include: Flea bites, Culture/isolati AB therapy Rodent/flea
susceptible clinical fever, direct on, IFA, must be control,
species: presentat lymphad contact serological started protective
chief ions: enitis/ab with testing within clothing, good
reservoirs bubonic scess infected the first sanitation/hyg
are (acute), formatio animals few iene,
rodents, septicem n; some , days of appropriate
birds, ic, species inhalati infectio use of PPE
lagomorph pneumo may on of n to be and standard
s; also nic; may show aerosoli effective medical
common include: high zed precautions
in acute mortality contami
carnivores fever, rates nants
painful
lymphad
enitis
smooth,
painful
lymph
gland
swelling
called a
bubo,
common
ly found
in the
groin,
but may
occur in
the
armpits
or neck,
most
often at
the site
of the
initial
infection
(bite or
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

scratch),
anorexia,
flulike
sympto
ms,
dyspnea,
fatigue;
gangrene
of the
extremiti
es such
as toes,
fingers,
lips, and
tip of the
nose;
vomiting
of blood;
blackene
d dots
scattered
over the
body;
delerium
; death

Coxiellosis (Q fever)

Coxiella Acute febrile Asymptomati Inhalation of Serological AB therapy Avoid contact with
burnetii; disease, c, aerosol testing infected
susceptible respirato although spores animals;
species: ry sometim from appropriate
cattle, involvem es causes infected use of PPE
sheep, ent, abortion birth and standard
goats; flulike fluid medical
many sympto and precautions
other ms, rumina
mammals pneumo nt
can be nia, placent
carriers meningo a; wool
encephal or
ilis and hides;
cardiac unpaste
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

involvem urized
ent; most milk
cases are from
mild and infected
self- animals
limiting; can lead
if left to
untreate human
d, causes infectio
fatal n
endocar
ditis

Salmonellosis (Enteric Fever)

Salmonella spp.; Incubation: 6- Four clinical Primarily Clinical AB therapy Good sanitation/
susceptible 72 hr; presentat fecal- presentati hygiene;
species: primaril ions: oral on/appro appropriate
almost all y subclinic route; priate use of PPE
species presents al, acute commo history, and standard
(especially as acute enteritis, nly culture/is medical
prevalent gastroent subacute found olation precautions;
in reptiles) eritis; enteritis, in beef proper
may also chronic and cooking/
include: enteritis poultry handling of
focal Acute: product beef/poultry
infection may s; products; do
s, include unthrift not bathe
chronic high y animals or
rheumat fever, appeara wash cage
oid explosive nce; items in
conditio diarrhea stress kitchen or
ns, (possibly can bathroom
colitis, bloody), induce sink; do not
autoimm depressio sheddin allow pets to
une n, death g of drink from
disorder within infectiv toilets; do not
s, 48 hr e give dogs pigs
chronic Chronic: organis ear/snout
enteric may ms chew treats;
hyperpla include use extreme
stic/ mild care when
inflamm symptom preparing/fee
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

atory s, low- ding pets a

conditio moderate bones and
ns; fever, soft raw food
shedding feces/mil (BARF) diet
of d
infected diarrhea,
organis abortion
ms
occurs
for days
to weeks

Staphylococcus aureus: Methicillin-resistant S. aureus (MRSA)

Staphylococcus Generally Generally Direct C&S of AB therapy Keep infected

aureus; start as start as contact suspicious as lesions
suseptable minor minor with or slow- indicate covered with
species: infection infection infected healing d from clean, dry
all; s, s, /coloni wounds; C&S bandages; use
When the (pimples (pimples zed tissue or results; appropriate
MRSA or boils or boils people nasal swab conscie PPE and
bacteria that are that are (often C&S to ntious standard
live on or erythmic erythmic, large help wound medical
in the , inflamed number determine care, precautions;
body, but inflamed and s of colonizati which practice good
do not and painful, individ on status may hand hygiene;
cause painful, with or uals in include dispose of
illness/dis with or without close surgical contaminated
ease, is without fever) but contact, incision bandage and
called fever) may such as and wound care
colonizatio but may quickly jails, drainag materials
n, and the quickly progress nursing e of promptly and
individual progress to a homes, lesion appropriately;
may be a to a large, schools) no sharing of
reservoir large, nonheali or personal
of nonheali ng, animals items; avoid
infection ng, necrotic ; participating
When the necrotic wound, through in close-
MRSA wound, or a sharing contact sports
bacteria or a serious, persona or skin-to-skin
live on or serious, life- l items contact until
in the life- threateni (sheets, all open
body and threateni ng towels, wounds are
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

do cause ng infection soap, completely

illness or infection razors, healed;
pathologic workou disinfect
al t/sports linens/clothin
conditions equipm g with very
is called ent), hot water and
infected contami dry using the
with nated high heat
MRSA; the workou setting;
two types t disinfect any
of MRSA benches contaminated
infection , hard surface
are: (1) saunas/ with 1:10
hospital- hot bleach
acquired tubs; solution
(HA) or contact
nosocomal with
infection purulen
and (2) t
Communit wound
y-acquired material
(CA) /banda
infection ges,
which
are
highly
infectio
us

Tuberculosis (TB)

Mycobacteria Two clinical May include Primarily Reaction to Human: anti- Intradermal
spp.; presentat lymphad fecal- interderm TB drug tuberculin
susceptible ions: enopathy oral al therapy testing
species: acute, , route; tuberculin /proph (animals and
most chronic lesions/g ingestio test(s), ylaxis vocationally
species of Acute: ranulom n of culture/is (for high-risk
mammals, may as of contami olation known persons),
avian, include organs, nated exposur animal
reptile, acute anorexia, food e) test/cull
amphibian miliary weakness product programs,
s, and fish TB, , weight s; appropriate
meningit loss, contact use of PPE
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

is, coughing with and standard

secondar /dyspne infected medical
y a, pleural tissues/ precautions;
infection pneumo animal proper
s nia, product preparation/h
Chronic: death; s andling of
may latent food
include carrier
pulmona state is
ry/bone common
/joint
lesions,
meningit
is,
genitouri
nary
infection
s,
cervical
lymphad
enitis

Tularemia (rabbit fever)

Francisella Incubation 2- Usually Blood/tissue Culture/isolati AB therapy Appropriate use of

tularensis; 3 days; manifests of on, FA PPE and
susceptible several as infected testing, standard
species: clinical septicemi animals serology medical
many presentat a (may , (later in precautions;
species of ions, show fluids/f disease) tick control,
vertebrates dependi high eces of sanitation/hyg
/invertebr ng on mortality infected iene
ates route of rates), ticks,
infection: heavy bites
ulcerogla tick from
ndular, infestatio infected
typhoida n may be ticks
l, concurre
oculogla nt
ndular,
glandula
r,
tularemi
 Symptoms: Symptoms: Transmissio
Cause Diagnosis Treatment Prevention Control
Human Animal n

c
pneumo
nia
C&S, Culture and sensitivity; CF, complement fixation; DIC, disseminated intravascular coagulation; ELISA, enzyme-linked
immunosorbent assay; FA, fluorescence antibody; IFA, indirect fluorescence antibody; PPE, personal protective equipment.

TABLE 18-2
Rickettsial Zoonoses

Symptoms: Transmissi Treatme Prevention

Cause Symptoms: Human Diagnosis
Animal on nt Control

Ehrlichiosis

Ehrlichia May include acute fever, Three clinical Primarily Clinical Antibiot Appropriate
spp.; flulike symptoms, presentati bite presentation/ ic use of
suscep leukopenia ons: acute, from appropriate (AB PPE
tible subacute, an history, IFA, ) and
species chronic; infect isolation from ther standar
: thromboc ed tissues apy d
primar ytopenia, tick, medica
ily elevated also l
canids hepatic oral precaut
enzyme (splas ions;
activity hed, tick
(especially infecti repelle
aspartate ve nts,
aminotran urine) prevent
sferase, , ion of
alanine place prolon
aminotran ntal ged
sferase) trans tick
May missio attach
include n ment,
fever, environ
anorexia, mental
depressio tick
n, treatme
lymphade nt,
nopathy, treatme
thromboc nt of
ytopenia, pets for
fadin ticks,
g puppy vaccine
syndrome availabl
e
 Symptoms: Transmissi Treatme Prevention
Cause Symptoms: Human Diagnosis
Animal on nt Control

Lyme Borreliosis (Lyme Disease)

Borrelia Three stages May include: Primarily Clinical AB Appropriate

burgdo First stage: fever, bite presentation/ ther use of
rferi; bulls eye arthralgia, from history of tick apy PPE
suscep red lesion (usually at arthritis, an exposure; and
tible site of tick bite), lameness, infect culture/isolati standar
species maculopapular/pete CNS ed on; IFA and d
: chial/vesicular involveme tick, ELISA medica
variety rashes, flulike nt, also available, but l
of symptoms encephalit oral false precaut
wild/d Second stage: is, (splas positive/negat ions;
omesti duration 3 days6 abortion hed, ive results tick
c wk, meningitis, infecti have been repelle
animal encephalitis, cardiac ve reported nts,
s complications, urine) prevent
musculoskeletal pain , ion of
Third stage (months place prolon
to years later): CNS ntal ged
involvement, trans tick
arthritis, chronic missio attach
dermatological n ment,
complications environ
mental
tick
treatme
nt,
treatme
nt of
pets for
ticks,
vaccine
availabl
e

Rocky Mountain Spotted Fever

Rickettsia May include: abdominal Similar to Primarily Clinical AB Appropriate

spp.; pain, flulike human bite presentation/ ther use of
suscep symptoms, rash on course of from appropriate apy PPE
 Symptoms: Transmissi Treatme Prevention
Cause Symptoms: Human Diagnosis
Animal on nt Control

tible palms/soles, CNS disease an history, CF and

species abnormalities, infect and micro-IFA standar
: hepatomegaly, ed (false positive d
variety jaundice, myocarditis, tick, is rare but medica
of meningoencephalitis, also false negative l
wild/d DIC oral occurs) precaut
omesti (splas ions;
c hed, tick
animal infecti repelle
s ve nts,
urine) prevent
, ion of
place prolon
ntal ged
trans tick
missio attach
n ment,
environ
mental
tick
treatme
nt,
treatme
nt of
pets for
ticks,
vaccine
availabl
e
CF, Complement fixation; CNS, central nervous system; DIC, disseminated intravascular coagulation; ELISA, enzyme-linked
immunosorbent assay; IFA, indirect fluorescence antibody; PPE, personal protective equipment.

TABLE 18-3
Viral Zoonoses

Symptoms: Symptoms: Prevention

Etiology Transmission Diagnosis Treatment
Human Animal Control

Arboviral Encephalitis (Sleeping Sickness)

Family Usually Symptoms Viral reservoir Culture/isola Antibiotic (AB) Avoid bite of
Arboviri biphasic vary but is tion, therapy mosquitoe
dae; First phase may maintaine serologic and s; use
examples may include: d by al testing antiviral protective
: eastern include fever, mosquito therapy in screening
equine headache/ depressio vectors humans /clothing;
encephal high fever, n, liberal use
omyelitis which impaired of insect
, western may abate vision, repellent
equine before irregular (with
encephal disease gait, DEET);
omyelitis progresses wanderin use of
, Second g, vaccines
Venezuel phase incoordin
an (encephali ation,
equine tic): slowed
encephal cervical reflexes,
omyelitis stiffness, facial/ge
, St. nausea/vo neral
Louis miting, paralysis,
encephal disorientat death
itis; ion,
susceptib frequent
le progressio
species: n to
many coma/seiz
birds/wi ures
ld
animals
(primaril
y rodent)
reservoir
s,
common
in
equines
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

Family Fever, malaise, Wide Close human RT-PCR; viral In humans: Because of the
Orthomy bone pain, spectrum contact culture neuramini natural
xoviridae blood of with from dase reservoir
; stained symptom domestic nasophar inhibitors species,
susceptib sputum, s, ranging poultry 3- yngeal (oseltamivi not able to
le diarrhea, from 7 days aspirates, r and eradicate
species: shortness asympto before monoclo zanamivir) virus;
avian, of breath, matic/mi illness; nal AB- as continuou
especiall elevated ld illness possible based treatment s
y wild alanine to a limited immuno and surveillan
waterfow aminotran highly aerosol fluoresce prophylaxi ce of flu
l, sferase, pathogen transmissi nt assay; s; strains in
migratin decreased ic avian on serology symptomat humans
g species, lymphocyt influenza human-to- of paired ic and birds
and e count, (highly human samples treatment (new
poultry; coagulopa contagiou (primarily (days 1-3 of strains are
mammal thy, s, severe patient to and days symptoms continuall
s rapidly and health 10-14) /pneumon y
include: progressiv rapidly care showing ia (if developin
exotic e fatal, workers); a develops) g);
felids, pneumoni with exposure 4 appropria
swine, a, severe mortality to wild, AB te use of
hoofstoc acute approach infected increase PPE and
k, respirator ing 100%) birds standard
whales, y distress with respirator medical
seals syndrome coughing y precautio
with , secretion/ ns; use of
multiorga sneezing, saliva/fec human flu
n failure, excessive es; spread vaccine in
death lacrimati among vocational
(some on, domestic ly high-
strains cyanosis poultry risk
approachi of farms via persons
ng 70% or unfeather contamina (to
more ed skin, ted birds decrease
human cranial or the
mortality) edema, inanimate possibility
ruffled vectors; of
feathers, virus can avian/hu
diarrhea, survive man flu
nervous several hybrid
system months in virus
disorders feces, 4-30 mutation);
, sudden days in avoid
death water, and contact
(often indefinitel with
with no y in frozen poultry
clinical material (live or
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

signs) dead)/po
ultry
farms and
live
poultry
markets;
good
personal
hygiene;
with
human
patients/s
amples:
minimize
aerosol/d
roplet
formation
with
immediat
e removal
and
proper
disposal
of dead
birds; use
of
airborne
isolation
rooms;
disinfectio
n: heat
sterilizatio
n, alcohol,
5% bleach,
formalin,
iodine
compoun
ds; during
an
outbreak:
rapid
destructio
n of the
entire
domestic
poultry
populatio
n, proper
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

disposal
of
carcasses,
rigorous
disinfectio
n of
farms,
mandated
quarantin
e, testing
before
importatio
n, restrict
movement
of live
poultry,
removal of
all ducks,
geese, and
quail from
retail
markets,
monthly
market
clean
days
(empty
and
disinfect
all birds
areas
simultane
ously)

Herpes B Viral Infection

Herpesvirus Causes an Chiefly Primarily by Culture/isola Thoroughly Thoroughly

simiae; ascending gingivost exposure tion, clean/disin clean/disi
susceptib encephaliti omatitis to infected serologic fect all nfect all
le s that is with monkey al testing primate bites/scra
species: usually buccal saliva/tiss bite/scratc tches;
primarily fatal; those mucosal h wounds; appropria
macaque who lesions; immediatel te use of
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

species survive asympto ues y report PPE and

(principa often have matic any standard
lly severe, infection rash/itchin medical
rhesus) permanent is g/numbne precautio
neurologic believed ss at ns; liberal
al damage; to be wound use of
symptoms common site; chemical/
usually evidence mechanica
occur suggests l restraint
within 30 that early
days of administrat
exposure; ion of
may acyclovir
include: may aid
vesicular recovery
skin
lesions,
localized
neurologic
al
symptoms,
regional
lymphade
nopathy,
fever,
headaches,
ataxia,
encephaliti
s,
deathu
sually 2-3
days after
onset of
clinical
signs

Newcastle Disease

An RNA Conjunctivitis, Respiratory: Virus can be Viral isolation Usually self- Good hygiene,
virus, swelling of gasping, aerosolize from resolving vaccinate
paramyx subconjun coughing d or tracheal in humans flocks
ovirus; ctiva; CNS: passed in exudate, with a live
especiall occasionall drooping feces; lung or vaccine;
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

y y systemic wings, improper spleen; use care

susceptib with twisted handling/ serologic when
le flulike neck, use of al testing handling
species: symptoms, paralysis, vaccine live
primarily lymphade depressio vaccine,
poultry, nitis of the n, appropria
also wild lymph anorexia te use of
birds nodes in Viscerotr PPE and
front of opic: standard
the ear acute medical
watery, precautio
green ns; avoid
diarrhea, creating
facial aerosols
edema, when
tracheal cleaning
exudate, or when
necrosis handling
of vaccine
intestinal
mucosa,
high
mortality
rate
associate
d with
this type

Poxviral Disease (Contagious Ecthyma, Bovine Papular Stomatitis, Pseudopox)

Family Usually Same course Direct contact Clinical AB therapy for Appropriate
Poxvirid progressiv as human (usually presentat secondary use of PPE
ae e, through ion/ bacterial and
localized dermal appropri infection standard
skin abrasion) ate medical
lesions/ve history, precautio
sicles, may culture/ ns; use of
progress isolation, vaccines
to cellular CF, IFA
proliferati
on/necros
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

is

Rabies (Hydrophobia, Mad Dog Disease)

Rhabdovirus; Incubation 9 Two stages Primarily Clinical Practice Immunization

susceptib days2 First contamina presentat prophylacti of
le yr, clinical stage: tion of a ion/ c treatment applicable
species: course duration wound appropri species,
all usually 2-8 1-6 days, (bite, ate preexposu
mammal days; may may abrasion) history, re
s include include by IFA prophylax
(commo anxiety, behaviora infected (optimal is for
n in hyperesthe l changes saliva; recovery vocational
skunk, sia, (unusual ingestion/ from ly high-
bats, hyperactiv friendline mucosal hippoca risk
dogs, ity, ss/ contact mpus, persons;
cats, increased aggressio with brain care when
horses) salivation, n), infected stem, handling
laryngoph excitabilit saliva cerebellu suspect
aryngeal y, altered m); animals;
muscular vocalizati histopath appropria
spasms, ons ologic te use of
seizures, Second samples PPE and
coma, and stage: of brain standard
ultimately duration tissue medical
death 1-4 days, (looking precautio
progressi for Negri ns
ve bodies)
paralysis
and
death

Variant Influenza Viruses (Swine Flu) Subtypes H1N1, H1N2, H3N2v

Family Fever, cough, Fever, Droplet RT-PCR test Antiviral drugs; Avoid crowds
Orthomy sore depressio inhalation or viral symptomat and sick
xoviridae throat, n, of culture ic people
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

; swine myalgia, barking aerosolize at treatment; and

populati headache, cough, d virus; laborator fluids; rest; animals;
ons can chills, ocular/n viral y; the hospitaliza avoid
be fatigue, asal transfer rapi tion may swine
infected nausea/vo discharge from d flu be barns,
by both miting, , contamina tests indicated if fairs, stock
human mental dyspnea, ted performe severe shows and
and confusion, ocular surfaces to d in the dehydratio exposure
avian seizures, inflamma mucous doctor n or to pigs;
influenza pneumoni tion, membrane s office respiratory vaccinate
viruses a, anorexia; s; contact and distress humans
(serving respirator infected with body acute develops with the
as hosts y system swine fluids, care annual flu
for both) collapse/f may including facilities vaccine;
ailure, show no diarrheal often use of
death signs of stools; give false appropria
illness; person-to- negative te PPE
generally person results; and take
high contact; only test standard
morbidity swine-to- high risk medical
, but low human or precautio
mortality contact; hospitali ns; wash
viral zed hands
transmissi individu thoroughl
on begins als; y and
~ 24 antibiotic frequently
hours therapy or use
BEFORE may be hand
symptoms indicated sanitizer;
develop if cover your
and secondar mouth
continues y and nose
for ~ 7- bacterial with a
10 days pneumo tissue
nia when you
develops cough/sn
eeze or
cough into
the crook
of your
arm;
dispose of
used
tissues
immediat
ely and
then wash
hands or
 Symptoms: Symptoms: Prevention
Etiology Transmission Diagnosis Treatment
Human Animal Control

use hand
sanitizer

West Nile Virus

A flavivirus; Most are Many are Viral reservoirs Culture/isola There is no Avoid
susceptib asymptom asympto maintaine tion, specific mosquito
le atic; fever, matic; d by serologic therapy, bites, use
species: headaches, acute mosquito al intensive protective
wild and illness, vectors, testing, supportive screening
birds, myalgia, fever, primarily MAC- therapy, /clothing,
especiall often with dysphagi Culex spp. ELISA, AB therapy liberal use
y crows, roseolar/ a/anorex In wild histopath to prevent of insect
jays, macopapu ia, birds ology, secondary repellant,
geese, lar rash seizures, populatio PCR infection, wear
birds of and paralysis, ns, ticks (tissues) good gloves
prey, regional and have been nursing when
domestic lymphade death found care handling/
equids, nitis; infected cleaning
also severe with game
domestic encephalic virus, but birds,
dogs and infection their role cook wild
cats, (West Nile in disease game
bears, neurologic maintenan thoroughl
crocodile al ce and y,
s, syndrome) transmissi conditiona
alligators may show on is l vaccine
, bats high fever, unclear for
cervical domestic
stiffness, equine
disorientat use,
ion, human
seizures, vaccine,
paralysis, human
coma, or blood
death (3%- product
15%) screening
CF, Complement fixation; CNS, central nervous system; DIC, disseminated intravascular coagulation; ELISA, enzyme-linked
immunosorbent assay; IFA, indirect fluorescence antibody; MAC, monoclonal antibody competition; PPE, personal protective
equipment; PCR, polymerase chain reaction; RT-PCR, reverse-transcription polymerase chain reaction.

TABLE 18-4
Parasitic Zoonoses

Symptoms: Symptoms: Transmissio Prevention

Cause Diagnosis Treatment
Human Animal n Control

Ancylostomiasis (Hookworm Disease) (Cutaneous Larval Migrans)

Many May include May include Fecal-oral Ova on fecal Anthelmin Good
species bloody anemia, route, flotation, tic sanitation
of diarrhea, dark/tarry cutaneo clinical thera /hygiene;
hookwo anemia stools, us presentation/a py treat
rms (which dehydration, penetra ppropriate infected
may may lead emaciation; tion by history animals;
infect to fatalities are larvae cover
humans tachycardi common in sandboxes;
and a, heart young appropriat
animals failure, animals e use of
; hypoprote PPE and
suscepti inemia, standard
ble ascites), medical
species: cutaneous precaution
most infection, s
species dermatitis
,
generalize
d edema,
regional
lymphade
nitis,
pneumoni
tis,
corneal
opacities

Cryptosporidiosis

Cryptosporidi Profuse, Often subclinical Primarily Detection of No specific Good

 Symptoms: Symptoms: Transmissio Prevention
Cause Diagnosis Treatment
Human Animal n Control

um watery in adult fecal- oocysts from thera sanitation

parvum diarrhea animals, oral feces, py; and
(coccidi with newborns/ju route histopathology suppo hygiene,
an abdomina veniles , ELISA, and rtive thorough
protozo l cramps, usually an thera disinfectio
an symptoms demonstrate immunofluore py n
parasite may recur, profuse scence test and procedure
); but is diarrhea nursi s;
suscepti often self- ng appropriat
ble limiting; care e use of
species: resolution PPE and
cattle, usually standard
cats, occurs medical
and within 30 precaution
other days, but s
domesti can be
c fatal
animals

Sarcoptic Mange (Scabies)

Sarcoptes Intensely Same as human Direct Visualization of Anthelmin Treat infected

scabei pruritic contact mites/ova tic animals,
mite; dermal with from skin thera protective
suscepti lesions, infested scraping py clothing,
ble may animal regular
species: develop washing/c
many alopecia/s hanging of
species kin animal
crusting/s bedding,
kin prophylact
thickening ic
, ivermectin
peripheral
lymphade
nopathy

Tapeworm Infection (Low Pathogenicity): Multiple Species

 Symptoms: Symptoms: Transmissio Prevention
Cause Diagnosis Treatment
Human Animal n Control

Dipylidium Common in Migrating Ingesting Primarily by Anthelmin Flea control;

spp., very proglottids infected presence of tic treat
Taenia young may cause fleas or proglottids on thera infected
spp., children, anal proglot feces/perianall py animals;
Hymeno symptoms irritation; tids/ov y (rarely good
lepis usually may include: a observed on sanitation
spp.; mild; may weight loss, fecal flotation) /hygiene
suscepti include: unthrifty
ble abdomina appearance
species: l
most discomfor
species t,
diarrhea,
pruritus,
anemia,
weight
loss

Tapeworm Infection (High Pathogenicity)

Echinococcus Alveolar See Tapeworm See Because of small Animals: See Tapeworm
spp.; hydatid Infection Tapewo size of anthel Infection
suscepti disease; (Low rm proglottids, mintic (Low
ble progressiv Pathogenicit Infectio very difficult thera Pathogenic
species: e onset of y) n (Low to detect on or py ity)
many symptoms Pathoge in feces, Huma
species may nicity) indistinguisha ns:
(commo include: ble ova (from surgic
n in epigastric other cestodes) al
dogs, pain, excisi
cats, malaise, on of
rodents) progressiv cysts
Predato e jaundice,
r-prey hepatome
cycle: galy,
predato hepatic
r cysts
species
are the
definitiv
e hosts,
prey
species
 Symptoms: Symptoms: Transmissio Prevention
Cause Diagnosis Treatment
Human Animal n Control

are
interme
diate
hosts,
human
is
(acciden
tal)
interme
diate
host

Toxocariasis (Visceral Larval Migrans [VLM], Ocular Larval Migrans [OLM])

Toxocara VLM: larval Usually Fecal-oral Ova found on fecal Anthelmin Good
spp.; migration inapparent (2-wk flotation, tic sanitation
suscepti through in adults incubat clinical thera /hygiene,
ble somatic (larval ion presentation/a py treat
species: tissues; encystation period) ppropriate infected
most may in tissues); in history, ELISA animals;
species include: young may appropriat
fever, include e use of
hepatome diarrhea, PPE and
galy, dehydration, standard
bronchioli intestinal medical
tis, distention/o precaution
asthma, bstruction, s;
pneumoni exaggerated prophylact
tis, CNS immunologi ic
OLM: cal response anthelmint
larva ic
enter into treatment
orbit of of
the eye, companio
usually no n animals
other
signs

Toxoplasmosis
 Symptoms: Symptoms: Transmissio Prevention
Cause Diagnosis Treatment
Human Animal n Control

Toxoplasma Most adults Most are Fecal-oral, Leukocytosis, Anticoccid Proper

gondii; show subclinical ingestio eosinophilia, ial handling/
suscepti subclinical but may n of observation/is anthel preparatio
ble symptoms include same improp olation of mintic n of food,
species: , but may symptoms as erly tachyzoites thera keep pet
most include: in humans cooked from py cats
species, flulike and possibly meats; blood/tissues, indoors
but cats symptoms icterus, congeni Sabin-Feldman (reduce
is , transient granulomato tal- dye test, IFA, hunting
definitiv cervical us panuveitis transpl CF, ELISA, opportunit
e and lymphade acental oocyst ies), clean
interme nopathy, transmi identification litter box
diate myocardit ssion from fecal regularly
host is, flotation (ova
splenome (requires require 3
galy, sporulation) or more
hepatome days
galy, incubation
encephalit before
is, infective),
retinochor good
oiditis; sanitation
congenital / hygiene,
infections gloves
may when
manifest a cleaning
subclinical litter
or clinical box/garde
presentati ning, cover
on of sandboxes;
variable appropriat
severity; e use of
fatalities PPE and
do occur standard
medical
precaution
s;
CF, Complement fixation; CNS, central nervous system; ELISA, enzyme-linked immunosorbent assay; IFA, indirect fluorescence
antibody; PPE, personal protective equipment.

TABLE 18-5
Mycotic Zoonoses

Symptoms: Prevention
Etiology Symptoms: Human Transmission Diagnosis Treatment
Animal Control

Dermatophytosis (Ringworm, Dermatomycosis)

Most Incubation 1-2 wk; Lesions are Direct contact Dermatophyte/myco Topical/o Protective
com superficial usually with an logical ral clothing,
mon: infections of circular infected culture/isolatio antif good
Micro skin/hair/nails /crusty, animal n, ultraviolet unga sanitation
sporu ; acute with or (or its fluorescence l /hygiene,
m inflammatory without hair, (Woods thera treat
spp., reaction; redness skin, lamp), py, infected
Tricho lesions usually /alopeci leashes/ biopsy/cytology vacci animals;
phyto papulosquamo a brushes) ne appropriat
n us with , (limit e use of
spp.; circular/redde equipme ed PPE and
susce ned borders nt, or use) standard
ptible (but may be contami medical
speci dry/alopecic nated precaution
es: or soil s
most moist/eczemat
com ous lesions)
mon
in
youn
g
mam
mals

Systemic Mycoses

Most Usually begin as Similar to Usually Culture/isolation, Antifunga Appropriate

com pulmonary course aerosoliz ELISA l use of PPE
mon: infection with of ed thera and
Histo fever/myalgia/ disease organis py standard
plasm congestion; in ms medical
a may progress human (fecal/in precaution
 Symptoms: Prevention
Etiology Symptoms: Human Transmission Diagnosis Treatment
Animal Control

spp., into fective s when

Cocci chronic/granul soil) handling
dioide omatous infected
s pneumonia or animals or
spp., disseminate to cleaning
Blasto other organs; their
myces may develop pens/sup
spp., into subacute plies
Crypt or chronic
ococc meningoencep
us halitis
spp.;
susce
ptible
speci
es:
most
speci
es
ELISA, Enzyme-linked immunosorbent assay; PPE, personal protective equipment.

TABLE 18-6
Prion/Transmissible Spongiform Encephalopathies

Symptoms: Treatmen Prevention

Etiology Symptoms: Human Transmission Diagnosis
Animal t Control

Bovine Spongiform Encephalopathy (Mad Cow Disease/Creuzfeldt-Jakob Disease)

Prion Incubation varies Similar to In animals: No reliable No Feed bans of

infect from months to course of consumption of laborat spec animal
ion; decades; once disease in prion- ory ific tissue to
susce symptoms humans, infected/conta tests, ther food
ptible develop, plus minated only apy animals;
speci disorder is hypersensit rendered histolo avail selective
es: usually fatal ivity, foodstuffs/ gical able DNA
cattle, within 1 yr; nervousnes tissues; exami for guides
sheep rapidly s, high- transplacental; nation prio breeding
, progressive stepping evidence of of n programs;
goats, dementia/cogn gait, genetic brain dise test/slaug
elk, itive imbalance, anorexia/w susceptibility tissue ase hter cattle;
deer, psychiatric/be eight loss, In humans: (florid at use of
exotic havioral pruritus, consumption of amyloi this disposable
hoofs abnormalities, excessive prion-infected d time surgical
tock coordination licking, meat (primarily plaque ; all instrument
deficits, ataxia; beef); direct format case s; prions
myoclonus, other inoculation; ion, s are exhibit
distinct transmissib implantation or presen fatal unusual
triphasic and le transplantation ce of resistance
polyphasic spongiform of infected spongi to
electrocardiogr encephalop materials/tissu form convention
am readings; athies: e lesions al and
noninflammato scrapie in ) physical
ry pathological sheep and decontami
process of the goats, nation
CNS exotic methods;
encephalop successful
athy, disinfectio
chronic n protocols
wasting include:
disease in 1 N
mule deer NaOH,
and elk, steam
feline/bovi sterilizatio
ne n at 212-
encephalop 250 F
athy (100-
 Symptoms: Treatmen Prevention
Etiology Symptoms: Human Transmission Diagnosis
Animal t Control

121 C)
with
exposure
to
formalin/f
ormic acid
solution,
0.09 N
NaOH for
2 hr with
steam
sterilizatio
n at 250
F (121
C) for
1 hr
CNS, Central nervous system.
I. Standard (medical) precautions
A. The minimum guidelines recommended by the Centers for Disease Control and Prevention
for reducing the risk for a transmission of blood-borne and other pathogens in hospitals
B. The standard precautions synthesize the major features of universal precautions (designed to
reduce the risk of transmission of bloodborne pathogens) and body substance isolation
(designed to reduce the risk for pathogens from moist body substances) and apply them to all
patients receiving care regardless of their diagnosis or presumed infection status
C. Standard precautions apply to
1. Blood, all body fluids, secretions, and excretions except sweat (regardless of whether
or not they contain blood), intact skin, and mucous membranes
2. The precautions are designed to reduce the risk for transmission of microorganisms
from both recognized and unrecognized sources of infection
3. Basically, when it comes to body fluids (except sweat), if it is wetand it is not
yoursyou need to protect yourself from it
II. Standard precautions entail hand washing/hygiene as a primary defense and standard
respiratory/cough etiquette
A. Hand washing with soap and water should occur whenever hands appear visibly soiled, if
spore-forming organisms are suspected, and after using the restroom
B. In other instances, the use of alcohol-based hand sanitizer may be used
C. Respiratory and cough etiquette requires people to cover their nose and mouth when
coughing/sneezing with tissue or mask, dispose of used tissues and masks promptly, and
perform hand hygiene after contact with respiratory secretions
1. If tissues or masks are not available, coughing/sneezing into the crook of the elbow
will help reduce microbial transmission
III. Standard (medical) precaution guidelines are further expanded into three transmission precaution
guidelines: contact, droplet, and airborne
A. More than one type of transmission precaution may be used at a time
B. Contact precautions are intended to prevent transmission of infectious agents that are spread
by direct or indirect contact with the patient or the patients environment
C. Contact precautions also apply where the presence of excessive wound drainage, fecal
incontinence, or other discharges from the body suggest an increased potential for extensive
environmental contamination and risk for transmission
D. Contact precautions utilize the use of personal protective equipment (PPE)
1. PPE includes the use of examination gloves, protective gowns, masks and/or N95
respirators, shoe covers/boots, eye protection and hair covers as indicated
2. In some cases, boots, foot baths, or dips may be warranted
3. All potentially contaminated items such as bandages and used PPE should be
disposed of promptly and correctly
4. Contaminated linens and nondisposable items should be disinfected as quickly as
possible
5. A gown and gloves for all interactions that may involve contact with the patient or
potentially contaminated areas in the patients environment are indicated
E. Airborne precautions are used to reduce the risk for airborne transmission of small particle
infectious agents that may remain in the air for an extended period
1. The transmission can occur by the dissemination of airborne droplets or dust
particles containing the infectious agent
2. Airborne transmission can cause organisms to be inhaled, moved great distances and
contaminate surfaces
 3. Special air handling and ventilation (negative-pressure rooms, high-efficiency
particular air [HEPA] filtration and increased room air exchanges per hour) are
necessary to reduce the risk for airborne transmission
4. N95 respirators or face masks are recommended in addition to gloves and gowns
F. Droplet precautions are intended to prevent transmission of larger particle pathogens spread
through close respiratory or mucous membrane contact with respiratory secretions or
coughing
1. Because these pathogens do not remain infectious over long distances (generally
< 3 feet), special air handling and ventilation are not required to prevent droplet
transmission
2. The use of a mask (for health care provider and patient) is indicated, in addition to
gloves and gown
G. Whenever there is doubt about what level of precaution should be taken, always err on the
side of caution and use more protection than may be needed

REVIEW QUESTIONS
1. Cat scratch disease/cat scratch fever:
a. Is caused by multiple bacterial species that live in the mouth and on the claws of domestic felids
b. Is caused by a rhabdovirus and spread to humans by cleaning infected litter boxes
c. Causes serious, acute illness in felids
d. Is not a real zoonotic disease

2. Choose the correct statement about ancylostomiasis.

a. The signs and symptoms vary markedly in humans and animals
b. It can be acquired if the larvae work their way into the skin of a person or animal
c. It is very difficult and expensive to detect, diagnose, and treat a hookworm infection
d. Keeping childrens sandboxes uncovered allows the suns ultraviolet rays to kill hookworm
larvae and keeps infection rates low

3. Leptospira is a spirochete that is primarily transmitted:

a. Through fecal-oral contamination
b. By being bitten by an infected bird
c. By contact with infected urine, water, soil, or animals
d. During an animals period of molting

4. Mycobacteria infection:
a. Generally causes hepatic dysfunction
b. Is detected using interdermal tuberculin testing, radiography, and culture and isolation
c. Can be controlled through childhood vaccination programs
d. Is only contracted by a few, select species

5. Toxocara spp.:
a. Can cause visceral larval migrans and ocular larval migrans in humans
b. Can infect most species of animals, as well as humans
c. Can cause intestinal obstruction in their host
 d. All of the above are true

6. MRSA:
a. In humans, often initially manifests as a small pimple or boil
b. Always results in a pathological condition (infection)
c. Is very difficult to transmit
d. Always results in amputation of the infected limb

7. Which of the following diseases is not transmitted by rickettsial organisms?

a. Tularemia
b. Rocky Mountain spotted fever
c. Lyme borreliosis
d. Ehrlichia

8. Tapeworm infections:
a. Are always highly pathogenic
b. Are transmitted when the tapeworm segments break off and grow into a new, fully formed adult
c. May be transmitted by eating an infected flea
d. Can be treated using antibiotics

9. Which of the following is recommended to reduce the exposure to, and transmission of, Avian
Influenza, type A viruses (i.e., subtypes H5N1, H5N2, H7N3, H7N7, H7N9)?
a. Use of appropriate PPE
b. Attending markets and farms where live poultry are housed or sold
c. Use of cold water to clean and disinfect premises, rather than chemical compounds or heat
sterilization method
d. Long-term storage of dead, possibly infected birds on poultry farms for future study and testing
purposes

10. The primary reservoir for the Chlamydia psittaci organism is:
a. The Dogwood Dam and Reservoir in Tennessee
b. Reptilian
c. Avian
d. Long-haired felids

11. Dermatophytosis (ringworm) infections:

a. Are parasitic infections
b. Exhibit lesions that are black, flat, and linear
c. Can be acquired by contact with contaminated skin, hair, equipment, bedding, or contaminated
soil
d. Can be acquired through the fecal-oral route

12. Select the correct statement regarding the rhabdovirus that causes hydrophobia.
a. There are multiple successful treatments for this disease
b. The incubation period for this disease is 9 days to 2 years
 c. No behavioral changes such as unusual friendliness or daytime activity by a typically nocturnal
species are seen
d. There is a simple laboratory test available to identify those who are infected with this disease

13. Salmonellosis can be transmitted:

a. By dog chew treats made from swine ears/snouts
b. By feeding a BARF diet to pets
c. By washing reptile cage items/dishes in the kitchen sink
d. All of the above

14. The primary vector for the West Nile Virus is:
a. Vampire bat
b. Nile crocodile
c. Wild avian species, such as crows, jays, and birds of prey
d. Mosquitoes primarily the Culex spp.

15. Choose the correct statement about scabies.

a. The lesions become thickened, lose hair, and are intensely pruritic in people, but not in animals
b. The signs and symptoms are not the same in humans and in animals
c. Microscopic examination of skin scraping will show mites and ova from infected lesions
d. The mites that cause scabies infections are microscopic and attach themselves to dust particles and
ride air currents to find a new host

16. Choose the correct statement about infections by Echinococcus spp.

a. The proglottids are very large, about the size of a kidney bean
b. Their definitive hosts are prey species
c. Treatment in humans requires an extensive course of anthelmintic therapy, spanning many months
d. Alveolar hydatid disease presents as jaundice, epigastric pain and hepatomegaly

17. Choose the correct statement regarding variant influenza viruses (i.e., H1N1, H1N2, and H3N2v).
a. Swine are susceptible to both human and avian influenza viral infections
b. Has a very high mortality in pigs
c. Transmission is primarily by the fecal-oral route
d. Rapid flu tests run in a physicians office or acute care facility are able to determine if a person
is infected with the swine flu quickly and accurately

18. Toxoplasmosis is caused by:

a. A nematode
b. A single celled parasite
c. A mite
d. Fungal spores

19. Choose the most correct statement regarding the Yersinia spp. that causes the plague.
a. It is transmitted by flea bites, inhalation of contaminants, or direct contact with infected animals
b. It can be prevented by vaccination in humans and animals
c. It has been eradicated everywhere, except for the Antarctic Circle
 d. It always causes acute mortality in its victims

20. Most infectious organisms have preferred host species. Which statement is the most correct?
a. If an individual is immunocompromised, an infection agent will always invade that individual
b. Infectious organisms will always invade any animal/host regardless of the immune status of that
individual
c. Infectious organisms will never invade outside their normally preferred host species
d. Infectious organisms may invade outside their normally preferred host species if an individual
host is sufficiently immunocompromised

CHAPTER 19

Pharmacology
DEFINITIONS AND BASIC TERMINOLOGY
I. A drug is any chemical compound used on or administered to humans or animals as an aid in the
diagnosis, treatment, or prevention of disease or other abnormal condition, for the relief of pain or
suffering, or to control or improve any physiologic or pathologic condition (Taylor, 2003)
II. A poison is a substance that, on ingestion, inhalation, absorption, application, injection, or
development within the body, in relatively small amounts, may cause structural or functional
disturbance (OToole, 2005)
A. The drugs we use in veterinary medicine to help our patients could very easily become
poisons if used inappropriately. All drugs are potential poisons
III. Drugs have a generic name usually derived from the chemical structure of the drug. A single generic
drug can have several trade or proprietary names
A. For example, the drug neomycin is the an active ingredient in the brand name products
Biosol, Tritop, Panalog, and Tresaderm
IV. In the United States and Canada drugs are approved by regulatory agencies after rigorous testing
and development
A. Approval is given for the specific doses, indications, and species that are tested
B. Using a drug in any way other than the approved way is called extra-label use
1. Veterinarians must often resort to extra-label use when there is no drug available that
is specifically labeled to treat the condition diagnosed in a particular patient
C. The Animal Medicinal Drug Use Clarification Act of 1994 provides legal guidelines to
veterinarians for extra-label drug use, and the American Veterinary Medical Association
published a brochure explaining those guidelines
V. Drugs are manufactured in many dosage forms
A. Capsules, tablets, solutions, suspensions, ointments, semisolids, and extracts are all
examples of dosage forms
B. Some drugs, particularly suspensions, are labeled shake well because of the
likelihood of particulates settling out of solution during storage
1. In general, it is a good idea to gently mix all solutions by rotating and rocking before
administration to ensure proper distribution of the drug particles, unless otherwise
specified by the manufacturer
VI. Drugs stored in the veterinary hospital must be maintained and handled correctly to ensure their
safety and efficacy as well as the safety of staff working with them
A. Drugs must be stored according to the environmental conditions (temperature, humidity,
light exposure), expiration date, and reconstitution recommendations on the label or package
insert
B. A Material Safety Data Sheet (MSDS) must be on file in the hospital for every hazardous
chemical used in the facility
1. Some drugs contain hazardous chemicals and have special handling procedures
prescribed by the Occupational Safety and Health Administration (OSHA). There are
numerous sources for obtaining information about the correct storage, use, and
disposal of hazardous drugs
VII. Drugs that have the potential to be abused are called controlled drugs and are under both Food and
Drug Administration (FDA) and Drug Enforcement Administration (DEA) regulation
A. These drugs are classified by the DEA according to their abuse potential and are denoted by
the symbols C-I (most abuse potential) through C-V (least abuse potential). Schedule I drugs
have no current acceptable medical use and will not be found in veterinary practices
B. Schedule II drugs are highly regulated drugs that have restricted medical uses, stringent
record keeping standards, and specific storage requirements
1. C-III to C-V drugs are generally treated in the same way in terms of required record
keeping and storage facilities
C. Canadian Food and Drug Act Schedules specify which drugs are over-the-counter (OTC),
prescription, controlled, and narcotic
1. Medications requiring prescriptions fall under three Federal Drug Schedules: F (part
1), G (controlled substances), and N (narcotics)
VIII. Drug withdrawal times are important in food animal medicine
A. Any drug given to a food animal can potentially be transferred to humans through ingestion
of animal products
B. Drugs dispensed for food animals have the withdrawal time listed on the label
C. Many books listing withdrawal times are available to the practitioner
D. Rules regarding extra-label use of drugs in food animals are more stringent than in
companion animals because of withdrawal time regulations
IX. Important information that can be obtained from the package insert or other drug references include
A. Indications: the approved uses of the drug
B. Precautions: usually mild side effects or adverse effects (any effect other than the intended
effect) that may occur with normal usage
C. Contraindications: situations in which the drug should NOT be used
D. Overdose: this section will describe the toxic effects that can occur when too much drug is
given or when a drug accumulates in the body
E. Dosage and administration: the recommended amount and route by which the drug should
be given
X. Compounded drugs
A. Compounding is a manipulation of a drug that is not provided for in an FDA-approved drug
label
1. When a therapeutic need cannot be fulfilled by an FDA-approved drug, compounded
drugs may play an important role in therapy
B. Reasons for compounding drugs
1. To provide a drug concentration more appropriate for the patient
2. To add flavoring to increase client and patient compliance
3. Alternative routes of administration
 a. Injectable products may be compounded to make topically applied forms,
oral products, or transdermal gels
C. Concerns with compounding
1. Slight changes can affect the drugs action
2. The efficacy and safety of a compounded drug is not scientifically tested
3. Alteration of a drug may change its performance in the patient, including residual
depletion in food animals
4. The veterinarian may be held liable if the compounded drug causes an adverse
reaction or therapeutic failure

PHARMACOKINETICS
I. A drug must reach its target tissue in the correct amount (within the therapeutic range), which must
be maintained for the correct amount of time, to exert the desired effect
II. Proper administration of a drug is critical and must include administering the right drug, at the right
time, by the right route, in the right amount, to the right patient. These five rights should be
verified whenever a drug is administered or dispensed
A. If at any time the medication orders are unclear, double-check them with the attending
veterinarian
B. Vials and containers of different drugs and different concentrations of the same drug may
have a similar label design. It is best to use the three checks system when preparing
drugs
1. Look at the drug name and concentration as you pull the bottle off the shelf
2. Look again as you are preparing the dose
3. Check a third time as you are returning the drug to the shelf
C. Watch concentrations carefully. Many drugs come in small animal and large animal
concentrations
1. Administering the correct amount of the incorrect concentration of drug could be a
fatal mistake
D. Drugs must be administered at specific time intervals that may vary by route of
administration to maintain a therapeutic level
1. For example, ingesta interferes with the absorption of some drugs, so timing doses
around mealtimes becomes important
E. Drugs labeled for one route of administration may not be absorbed and may be dangerous if
administered by other routes
1. Never give a drug intravenously (IV) unless it is specifically labeled for intravenous
use, or the attending veterinarian has verified that route of administration
2. Drugs are generally administered either orally (PO), by injection (subcutaneously [SC
or SQ], intramuscularly [IM], and IV most commonly), topically (skin, eye, ear), or by
inhalation
III. Therapeutic index (TI) is the relationship between a drugs ability to achieve the desired
effect compared with its tendency to produce toxic effects (Wanamaker and Massey, 2008)
A. TI is the comparison between a drugs ability to reach the desired effect and its tendency
to produce toxic effects
1. TI is expressed as a ratio between the LD (dose of a drug that is lethal in 50% of the
50

animals in a trial) and the ED (dose of a drug that is effective in 50% of the animals in
50

a trial): TI = LD /ED
50 50

2. The larger the number for the TI, the safer is the drug. Drugs with lower TI numbers,
such as those used to treat cancer, tend to be more toxic
 3. The more toxic drugs are usually also more hazardous for veterinary staff to handle
IV. After administration (except topical), a drug must make its way to the bloodstream (absorption) and
then into the intended tissues (distribution)
A. Absorption and distribution depend on several factors in the body and certain characteristics
of the drug
1. pK (ionization tendency) of the drug
a

2. pH (acidity or alkalinity) of the tissues

3. Solubility of the drug
4. Perfusion of the tissues
5. Volume of distribution (Vd)
6. Other factors, such as the blood-brain barrier
B. Orally administered drugs travel to the liver before reaching the systemic circulation and
may be removed before they are able to affect the rest of the body
1. This is called the first-pass effect
V. When a drug reaches its target tissues it has either a receptor-mediated or a nonreceptor-mediated
effect. Drugs can:
A. Bind to a receptor site and cause the cell to react (agonist) or prevent a reaction (antagonist)
B. Interact with ions in the body to create a chemical reaction
C. By their physical presence of the drug, facilitate a reaction
VI. The process of eliminating a drug from the body usually requires biotransformation (metabolism)
and excretion
A. Changes in the chemical structure of drugs are caused by the liver and, to a lesser degree,
other organs
1. Resulting drug components are termed metabolites
a. The metabolites of a drug may be pharmacologically active
b. In some instances the metabolites may be toxic to the animal
B. Circulating metabolites are usually filtered into the urine through the kidneys, although they
may also be excreted in the feces, sweat, or through respiration
1. Monitoring hydration status becomes critical with such drugs as aminoglycosides,
which are nephrotoxic and excreted by the kidneys
2. Patients with decreased liver or kidney function may not be able to eliminate drugs
efficiently
C. Oral drugs that are not absorbed pass through the intestine unchanged and are excreted in
the feces

CLASSES OF DRUGS
I. Drugs are divided into different classes according to the effect they have on the body; drugs will often
have multiple effects on different body systems
II. One drug may have multiple indications for use
A. For example, diazepam (Valium) is used for sedation, appetite stimulation, and short-term
seizure control

ANTIMICROBIAL DRUGS
I. Antimicrobials are drugs that kill or inhibit the growth of microorganisms, such as bacteria, viruses,
and fungi (Table 19-1). Antimicrobials are classified by the type of organism they fight and whether
they kill (-cidal) the organism or only prevent its replication (-static).Table 19-1 provides details about
some commonly used antimicrobial drugs
TABLE 19-1
Antimicrobials

Generic Trade name(s) Route(s) Notes

Aminoglycosides

Amikacin Amiglyde-V IV, IM, SC, Keep animal well hydrated; possible
intrauterine nephrotoxic, ototoxic effects

Gentamicin Gentocin, Garasol IV, IM (stings), SC Keep animal well hydrated; possible
(stings), PO nephrotoxic, ototoxic, neurotoxic effects
(water additive),
topical

Neomycin Biosol IV, IM, SC, PO, Not absorbed well systemically; highly
topical nephrotoxic when given parenterally

Tobramycin Tobrex ophthalmic; no Ophthalmic, IV, IM, Systemic use: nephrotoxic, ototoxic, neurotoxic
veterinary- SC effects
approved
parenteral products
in United States

Kanamycin Ingredient in Amforol PO Amforol also contains GI protectants;

bactericidal activity within gut only (not
absorbed)

Penicillins

Amoxicillin Amoxi-Tabs, Amoxi- IV, IM, SC, PO, Give with food if GI upset occurs
Inject, Biomox, intramammary
Generic Trade name(s) Route(s) Notes

Amoxi-Mast

Amoxicillin with Clavamox PO An alternative for bacteria that have developed

clavulanic acid resistance to amoxicillin

Ampicillin Polyflex IV (slow), IM, PO Do not give orally to rabbits

Carbenicillin Geocillin PO Antipseudomonal

Penicillin G Crystacillin, Flocillin, IV, IM, SC, PO Route of administration depends on drug form
Dual-Pen (potassium, procaine, benzathine, etc.)
Check label and do NOT give cloudy
solutions intravenously unless specifically
instructed

Penicillin VK Veetids PO Best penicillin for oral administration

Pen-Vee K

Ticarcillin, ticarcillin Ticar, Timentin IV, IM, topical, Injectable form often used in combination with
with clavulanic intrauterine aminoglycosides; they should not be
acid mixed in the same syringe

Cloxacillin, Cloxacillin: Cloxapen, PO, intramammary; Therapeutic equivalent penicillinase-resistant

dicloxacillin, Dri-Clox, Dari-Clox oxacillin: IV, IM, penicillins
oxacillin SC, PO

Cephalosporins
Generic Trade name(s) Route(s) Notes

Cefadroxil Cefa-Tabs, Cefa-Drops PO First-generation cephalosporin; cephalosporins

should not be used in patients with
known allergy to penicillin

Cefazolin Ancef, Kefzol IV (slow), IM, SC First-generation cephalosporin

Cephalexin Keflex PO First-generation cephalosporin

Cephapirin Cefadyl, Cefa-Lak IV, IM, SC, First-generation cephalosporin

intramammary

Cefoxitin Mefoxin IV, IM, SC Second-generation cephalosporin

Cefaclor Ceclor PO Second-generation cephalosporin

Cefotaxime Claforan IV, IM, SC Third-generation cephalosporin

Cefovecin Convenia SC Third-generation cephalosporin provided as a

long-acting (7-14 days) SC injection
Generic Trade name(s) Route(s) Notes

Ceftiofur Naxcel IM Third-generation cephalosporin; do not use if

precipitate forms that does not dissipate
with warming

Ceftriaxone Rocephin IV, IM Third-generation cephalosporin; long half-life;

achieves high concentration in CNS

Ceftazidime Fortaz IV, IM, SC Third-generation cephalosporin; especially

useful in reptiles

Cefpodoxime Vantin, Simplicef PO Oral third-generation cephalosporin; once

daily dosing

Cefixime Suprax PO Oral-third generation cephalosporin

Cefepime Maxipime IV, IM Fourth-generation cephalosporin; reserve for

highly resistant organisms

Tetracyclines

Tetracycline Panmycin IV (slow), IM, PO Tetracyclines may cause tooth discoloration in

prenatal and neonatal animals

Doxycycline Vibramycin, Doxy 100, IV, PO, periodontal Longer half-life, better CNS penetration than
Doxirobe Gel gel tetracycline
Generic Trade name(s) Route(s) Notes

Oxytetracycline Oxytet, Liquamycin, IV, IM, PO Many veterinary products and uses, including
Terramycin feed additive

Quinolones

Ciprofloxacin Cipro IV, IM, SC, PO Rarely used in veterinary medicine;

quinolones as a class should not be used
in growing animals because of risk for
damage to cartilage

Difloxacin Dicural PO Veterinary drug; approved for use in dogs,

may cause GI upset in cats

Enrofloxacin Baytril, Baytril Otic IM, PO, topical Veterinary drug; similar to ciprofloxacin with
better bioavailability in animals; avoid
use in renal failure patients

Orbifloxacin Orbax PO Veterinary drug

Marbofloxacin Zeniquin PO Newest veterinary-approved fluoroquinolone

Moxifloxacin, Ophthalmic For corneal infections with gram-negative

norfloxacin, organisms
ofloxacin

Lincosamides and Macrolides

Generic Trade name(s) Route(s) Notes

Clindamycin Antirobe IM (stings), SC, PO Do not administer to rabbits, hamsters, guinea

pigs, and horses

Lincomycin Lincocin IV, IM, PO Clindamycin is usually chosen over lincomycin

because it is more bioavailable and less
toxic

Erythromycin Erythro-100, 200 IV (slow), IM Enters prostate but not CNS; also used as a
(stings), PO prokinetic to facilitate gastric emptying

Azithromycin Zithromax PO Better absorption, longer half-life, and better

tolerated than erythromycin

Tylosin Tylan Soluble Powder IM, PO (in food) Powder form may be used for management of
chronic colitis

Sulfonamides

Sulfadiazine- Tribrissen, Di-Trim IV, SC, PO Can precipitate in the kidneys of dehydrated
trimethoprim animals; can cause keratoconjunctivitis
sicca

Sulfadimethoxine Albon IV, IM, SC, PO Sulfas are coccidiostatic

Sulfasalazine Azulfidine PO Used for inflammatory bowel disease

(antibacterial and antiinflammatory)
Generic Trade name(s) Route(s) Notes

Miscellaneous

Chloramphenicol Chloromycetin IV, IM, SC, PO Penetrates CNS; may cause aplastic anemia in
humans; do not give to food animals
(banned by the FDA)

Florfenicol Nuflor IM, SC May be used when chloramphenicol is

contraindicated

Imipenem-cilastatin Primaxin IV, IM May be useful for serious infections when

other antibiotics have failed; must be
given parenterally; chloramphenicol may
antagonize; read insert for potential
adverse effects and contraindications

Metronidazole Flagyl IV, PO Antiprotozoal; may be neurotoxic and

immunosuppressive at higher dosages

Antifungals

Amphotericin B Fungizone, Abelcet IV (rapid or slow Can cause severe toxicity; should be used to
(AMB) bolus) treat potentially life-threatening disease
only (systemic mycoses); lipid-based
formulation recommended

Flucytosine Ancobon PO Used in combination with AMB for

Cryptococcus
Generic Trade name(s) Route(s) Notes

Fluconazole Diflucan IV, PO Fungistatic; probably most useful for CNS

infections

Griseofulvin Fulvicin U/F PO Known teratogen in cats

Itraconazole Sporanox PO Information on safety and toxicity limited

Ketoconazole Nizoral PO Much less toxic than AMB; used for similar
systemic fungal infections; also used in
conjunction with cyclosporine to reduce
dose required

Nystatin Panalog, Derma-vet, PO, topical Used to treat GI and skin Candida infections
Quadritop
Mycostatin

Miconazole Monistat, Conofite, Topical Used to treat fungal ophthalmic infections

Micaved

Terbinafine Lamisil PO, topical Used to treat dermatophytosis, avian mycoses

Antivirals

Acyclovir Zovirax IV, PO, topical Used for feline herpes infection and
Pachecos disease in birds
Generic Trade name(s) Route(s) Notes

Idoxiuridine, Viroptic Topical Ophthalmic antivirals for feline herpes

trifluridine infection

Interferon-alpha 2a Roferon-A PO For treatment of nonneoplastic feline leukemia

virus infections in cats

Oseltamivir Tamiflu PO Used anecdotally in treatment of parvoviral

enteritis and other mucosal
superinfections
IM, Intramuscular; IV, intravenous; PO, orally; SC, subcutaneous.
II. Antimicrobials are the most commonly prescribed drugs in veterinary medicine
A. For an antimicrobial to be effective
1. Organism must be susceptible to the drug selected
2. Drug must be able to penetrate the site of infection at an effective concentration for
an appropriate length of time to kill or inhibit the organisms
3. Patient must be able to tolerate the treatment
B. Bacterial resistance to antibiotics is a major problem in human and veterinary medicine and
can make successful treatment of a bacterial infection very difficult
1. Resistance is created when bacteria develop the ability to survive in the presence of
an antibiotic drug; they pass on this resistance to subsequent generations of bacteria
2. When treatment with an antibiotic is insufficient to kill off a bacterial population,
resistance can result
C. Technicians must educate clients about the importance of administering medications at
home as directed and for the entire course prescribedeven if the animal appears to be
better after a few days
III. Antimicrobial agents work via one of five mechanisms
A. Disruption of the development of microbial cell wall (e.g., penicillins)
1. Interfering with the formation of the cell wall causes the cell to lyse during the
growth stage
2. Giving a bacteriostatic antibiotic (thus stopping bacterial growth) concurrently with
this type of medication would prevent it from working
B. Damaging the cell membrane in static/adult populations (e.g., polymyxins)
1. Change in permeability allows
a. Drugs to diffuse into the bacterial cell
b. Bacterial structures to diffuse out, collapsing the cell
C. Interference with microbial protein synthesis
1. Aminoglycosides are bactericidal
a. They make their way into the bacteria and attach to the ribosomes,
rendering the bacteria unable to produce vital proteins
2. Tetracyclines, lincosamides, chloramphenicol, and macrolides use the same method
but are bacteriostatic
D. Inhibition of nucleic acid production
1. Because this method interferes with DNA and/or RNA synthesis, the potential exists
for mutations and birth defects to occur in patients receiving these drugs
2. Griseofulvin, ketoconazole, and metronidazole are drugs that work via this
mechanism
3. Enrofloxacin (Baytril) works via this method, but is selective for bacterial DNA
E. Disruption of microbial metabolic activity (e.g., sulfa drugs)
1. This usually prevents bacteria from dividing; therefore such drugs are bacteriostatic

ANALGESIC AND ANTIINFLAMMATORY DRUGS

I. These drugs are two separate classes but are used for a similar purpose: pain control (Table 19-2)

TABLE 19-2
Analgesics and Antiinflammatories
Generic Trade name(s) Route(s) Notes

Nonsteroidal Antiinflammatory Drugs

Acetaminophen Tylenol PO Analgesia; do not use in cats; causes

methemoglobinemia and liver damage

Acetylsalicylic acid Aspirin PO Analgesic, antiinflammatory, and antipyretic; use

with caution in cat; enteric coating can
prevent gastric irritation

Carprofen Rimadyl IV, IM, SC, PO Labrador retrievers may be more prone to severe
adverse effects

Deracoxib Deramaxx PO Cyclooxygenase (COX)-1 sparing; approved for

dogs only

Etodolac EtoGesic, Lodine PO COX-2 selective; approved for dog only

Firocoxib Previcox PO COX-2 selective; chewable tablets; approved for

dogs only

Flunixin meglumine Banamine IV, IM, PO May cause gastric ulceration, nephrotoxicity; keep
patient hydrated

Ketoprofen Ketofen, Orudis IV, IM, SC, PO

Generic Trade name(s) Route(s) Notes

Meloxicam Metacam IV, SC, PO COX-2 selective; used for chronic or acute
musculoskeletal disorders; approved for use
in cats

Phenylbutazone Many Analgesic, antiinflammatory, and antipyretic

Piroxicam Feldene PO Use in cat is as an antineoplastic

Robenacoxib Onsior PO Approved for cats only (up to 3 days)

Tepoxalin Zubrin PO COX and LOX (lipooxygenase) inhibitor; rapidly

disintegrating tabs for dogs

Tolfenamic acid Tolfedine IM, SC, PO Pharmacologically similar to aspirin; approved for
dogs and cats in Canada, Europe

Dimethyl sulfoxide IV, topical Teratogenic in some species; wear gloves when
(DMSO) applying

Corticosteroids

Betamethasone Betasone IM Long acting

Dexamethasone Azium, Dexasone IV, IM, SC, PO Long acting

Generic Trade name(s) Route(s) Notes

Methylprednisolone Medrol, Depo- IM, SC, PO Intermediate acting

Medrol

Triamcinolone Vetalog IM, SC, PO Intermediate acting

Prednisone Meticorten, IV, IM, SC, PO Intermediate acting

Deltasone

Hydrocortisone Cortef IV, IM, PO Short acting

Glycosaminoglycans

Glucosamine Many PO Often combined with chondroitin, these agents are

considered nutraceuticals, not drugs

Hyaluronate (hyaluronic Hycoat IA For synovitis

acid)

Polysulfated Adequan IM, IA Postinjection inflammation possible when

glycosaminoglycan administered into the joint

Pentosan polysulfate Cartrophen Vet IM, SC, PO Used for osteoarthritis and interstitial
(outside
Generic Trade name(s) Route(s) Notes

United States), cystitis (cats)

Elmiron

Muscle Relaxants and Opioid (Narcotic) Analgesics

Methocarbamol Robaxin-V IV, PO Skeletal muscle relaxant, may cause sedation

Butorphanol Torbutrol, IV, IM, SC, PO Partial agonist/antagonist; poorly absorbed from
Torbugesic, gastrointestinal tract; also used as an
Dolorex antitussive

Buprenorphine Buprenex IV, IM, SC, TM Partial agonist; may cause respiratory depression;
TM administration in dogs is unreliable

Hydromorphone Dilaudid IV, IM, SC, rectal Mu agonist; may cause panting, then respiratory
depression; Class II controlled substance

Morphine Many IV, IM, SC, PO, Mu agonist; may cause panting, then depression;
rectal, use preservative-free form for epidural; Class
epidural II controlled substance

Nalbuphine Nubain IV, IM Mixed agonist/antagonist similar to butorphanol,

not scheduled as a controlled substance in the
United States

Oxymorphone Numorphan IV, IM, SC May cause respiratory and cardiac depression;
Class II controlled substance
Generic Trade name(s) Route(s) Notes

Fentanyl Duragesic, IV constant-rate Patch gives about 3 days of analgesia; injectable is

Sublimaze infusion, short acting; Class II controlled substance
transdermal

Tramadol Ultram PO Synthetic mu agonist and serotonin,

norepinephrine reuptake inhibitor

Local Anesthetics

Lidocaine, mepivacaine, Many Local infusion, These drugs are used to block nerve impulses from
procaine, tetracaine topical, local or regional areas; they are available in
transdermal, injectable and topical forms; epinephrine is
epidural sometimes added to extend the effects

Miscellaneous

Amantadine, Symmetrel, PO N-methyl-D-aspartate receptor antagonists; adjunct

dextromethorphan Robitussin to analgesia use is experimental

Gabapentin Neurontin PO Analgesic and anticonvulsant adjunct;

experimental used for chronic and
neuropathic pain
IA, Intraarticular; IM, intramuscular; IV, intravenous; PO, oral; SC, subcutaneous; TM, transmucosal.
II. Examples are opioid (narcotic) analgesics, corticosteroids, and nonsteroidal antiinflammatory drugs
(NSAIDs)
A. Opioid analgesics include morphine, meperidine, oxymorphone, butorphanol, and codeine
1. These drugs block the pain impulse in the brain, and therefore reduce the perception
of pain, but do not address the cause or source of the pain
B. Opioids are used frequently as perianesthetic agents because of their analgesic and
concurrent sedative effects
1. A common side effect is respiratory depression, although panting may be seen
initially
C. Dexamethasone and prednisone are two commonly used corticosteroids
1. Corticosteroids act as analgesics by reducing tissue inflammation
2. Corticosteroid drugs can have significant effects on the endocrine and immune
systems; therefore extra care must be taken with their use
3. Corticosteroids should not be given concurrently with NSAIDs
D. Phenylbutazone, aspirin, ibuprofen, etodolac, and carprofen are examples of NSAIDs
1. NSAIDs will not produce sufficient analgesia to counteract pain associated with
organs or broken bones
2. Most NSAIDs work by blocking prostaglandin production from within the
inflammatory process. They are safer but less effective than steroidal
antiinflammatory drugs
3. Cats lack the ability to metabolize many NSAIDs; therefore NSAIDs should be used
only with extreme caution on the direction of a veterinarian
4. Adverse effects, particularly with long-term use, include gastrointestinal (GI)
ulceration and liver damage
E. Narcotic agonist drugs (many opioid analgesics) are competitively antagonized by naloxone
(Narcan) and naltrexone (Trexan)

ANESTHETIC DRUGS
See (Table 19-3)also Chapters 21 and 27.

TABLE 19-3
Anesthetics and Other Central Nervous System Drugs

Generic Trade name(s) Route(s) Notes

Barbiturates

Pentobarbital Nembutal IV (slow to Used for induction of general anesthesia and to manage status
effect) epilepticus; can be used as a single agent for euthanasia;
Class II controlled substance; short-acting
Generic Trade name(s) Route(s) Notes

Pentobarbital with Beuthanasia-D IV For euthanasia only

phenytoin

Thiopental Pentothal IV only May adsorb to plastic intravenous bags and lines; ultrashort
acting

Tranquilizers and Sedatives

Acepromazine PromAce, IV, IM Do not use in conjunction with organophosphates; may cause
Atravet (stings) paradoxical CNS stimulation, hypotension
, SC,
PO

Buspirone BuSpar PO Anxiolytic for chronic use in behavior-control programs; not for
acute anxiety

Diazepam, Valium, Versed IV, IM, PO, Used as anxiolytic, muscle relaxant, appetite stimulant,
midazolam rectal perianesthetic, and anticonvulsant

Oxazepam, Serax, Xanax PO Used primarily in behavior modification programs

alprazolam

Dexmedetomidine Dexdomitor IV, IM Alpha-2 agonist used for sedation and analgesia in young,
healthy animals; adverse effects, such as bradycardia, can be
treated by reversing the drug

Xylazine Rompun, IV, IM, SC Alpha-2 agonist used for sedation and analgesia in young,
Generic Trade name(s) Route(s) Notes

Anased healthy animals; available in 20 and 100 mg/mL; check

concentration before administering; respiratory depression
and vomiting are common side effects and can be treated by
reversing the drug

Inhalants

Isoflurane Aerrane, Forane Inhalant Rapid induction and recovery; noxious odor

Sevoflurane SevoFlo Inhalant Very rapid induction and recovery; no odor

Miscellaneous Anesthetics

Ketamine Ketaset, Vetalar IV, IM Dissociative anesthetic; most reflexes and muscle tone are
maintained; no somatic analgesia

Propofol Rapinovet, IV only Rapid induction and recovery; drug is carried in an egg
PropoFlo, lecithin/soy base, which supports bacterial growth
Diprivan

Tiletamine and Telazol IV, IM Tiletamine is a dissociative anesthetic; zolazepam is a

zolazepam tranquilizer; most reflexes are retained

Etomidate Amidate IV Minimal effects on cardiovascular and respiratory system; given

alone causes myoclonus
Generic Trade name(s) Route(s) Notes

Guaifenesin Guailaxin IV, PO Muscle relaxant perianesthetic when given parenterally;

expectorant when given orally

Anticonvulsants

Phenobarbital Luminal IV (slow), Usual first drug of choice for idiopathic epilepsy; may be used
IM, PO for status seizure; long acting

Bromides (Potassium, PO Used as an adjunct in management of idiopathic epilepsy

sodium)

Diazepam Valium IV, rectal, Used to control seizures in progress

intrana
sal

Pentobarbital Nembutal IV Used in status epilepticus, for intractable seizures

Levetiracetam Keppra PO Adjunct used in refractory epilepsy

Zonisamide PO Adjunct used in refractory epilepsy

Others
Generic Trade name(s) Route(s) Notes

Edrophonium, Tensilon, IV, PO Anticholinesterase agents used to diagnose and treat myasthenia
pyridostigmine Mestinon gravis

Succinylcholine, Anectine, IV Neuromuscular blocking agents; paralytics

pancuronium Pavulon
CNS, Central nervous system; IM, intramuscular; IV, intravenous; PO, oral; SC, subcutaneous.
I. General anesthetics cause the loss of all sensation
II. General anesthetics are available as injectables and inhalants
III. Overdoses of some general anesthetics are used for euthanasia, although an overdose of any general
anesthetic can be fatal
A. Pentobarbital sodium is the most common euthanizing agent
B. By itself, pentobarbital is a C-II drug in the United States (DEA) and a controlled drug in
Canada; but some euthanasia agents contain additives, such as phenytoin in Beuthanasia-D or
lidocaine in FP3. These additives act as cardiac depressants and change the DEA status to C-
III in the United States
1. Pentobarbital sodium can cause necrosis if injected perivascularly
2. Perivascular injection will delay or inhibit death
3. Animals in pain may require a tranquilizer before pentobarbital sodium
administration
4. These products must not be used in food-producing animals
5. The carcass will be toxic to scavengers that ingest tissues

OTHER NERVOUS SYSTEM DRUGS

I. Many types of drugs have various effects on the nervous system (see Table 19-3). They can affect both
the central (brain and spinal cord) and the peripheral (autonomic) nervous systems
II. Drugs that affect the central nervous system include anesthetics, analgesics, tranquilizers, sedatives,
anticonvulsants, stimulants, and psychoactive drugs. Most of these drugs are federally controlled
substances
A. Tranquilizers and sedatives, such as benzodiazepines and phenothiazine drugs, reduce
anxiety, produce a tranquil mental state, and cause sleepiness
B. Anticonvulsants used to control seizures in progress are administered in the hospital for
relatively short durations (e.g., diazepam and pentobarbital)
C. Anticonvulsants used for long-term management of seizure-prone patients are usually given
orally at home on a long-term basis (e.g., phenobarbital and potassium bromide)
D. Doxapram is used to stimulate the respiratory center in the brain
E. Other stimulants, such as caffeine, theobromine, and amphetamines, are frequently toxic to
animals
F. Drugs are sometimes used to treat behavioral problems in animals
1. Many of these are human psychiatric medications that have not been approved for
use in animals
2. They may have undesirable side effects and can take a long time to work
a. Clomipramine (Clomicalm) is a veterinary-labeled tricyclic antidepressant
used to treat separation anxiety in dogs
b. Selegiline (Anipryl) is a veterinary-labeled antidepressant used in the
treatment of canine cognitive dysfunction
c. Fluoxetine (Reconcile) is a veterinary-labeled SSRI used to treat separation
anxiety and other problems such as obsessive-compulsive behaviors
III. Drugs that affect the autonomic nervous system can be simply classified by the system they affect
A. Cholinergics produce parasympathetic effects; anticholinergics block them
1. These drugs work by stimulating or blocking different receptors and/or stimulating
or blocking the effects of various neurotransmitters
a. Examples of cholinergic agents include:
(1) Pilocarpine, which reduces intraocular pressure
(2) Metoclopramide, which stimulates the GI system
 (3) Urecholine, which stimulates the urinary system
b. Adverse side effects of cholinergics are related to overstimulation of the
parasympathetic nervous system
2. Anticholinergics have the opposite effects, including:
a. Slowing GI motility (aminopentamide)
b. Drying secretions, dilating the pupil, and speeding the heart (atropine
sulfate, glycopyrrolate)
c. Adverse side effects are dose related
(1) For example, care must be taken not to confuse the large animal
concentration with the small animal concentration of atropine
sulfate
B. Adrenergics produce sympathetic effects; adrenergic blockers inhibit them
1. Adrenergic agents have many diverse effects according to the receptors stimulated
a. Some of the most common include:
(1) Epinephrine stimulates the heart to beat
(2) Dopamine is used to treat hypotension and shock
(3) Phenylpropanolamine is used for urinary incontinence
(4) Terbutaline and albuterol are used for bronchodilation
(5) Xylazine and medetomidine are analgesic and sedative agents
2. Similarly, adrenergic blockers are a diverse group. Some of the more common alpha
blockers include:
a. Phenoxybenzamine, to reduce urethral sphincter tone
b. Acepromazine and droperidol, which are tranquilizers
c. Yohimbine, the reversal agent for xylazine, and atipamezole (Antisedan), the
reversal agent for dexmedetomidine
3. Of the beta blockers, propranolol, used for cardiac arrhythmias and cardiomyopathy,
and timolol, used to treat glaucoma, are most commonly used in veterinary practice

CARDIOVASCULAR DRUGS
Cardiovascular drugs affect the heart. They include antiarrhythmics, diuretics, positive inotropic drugs,
catecholamines, and vasodilators (Table 19-4). The cardiovascular system is regulated by the autonomic
nervous system, and many of the drugs that affect it work by stimulating or blocking nervous impulses.

TABLE 19-4
Cardiovascular Drugs

Generic Trade name(s) Route(s) Notes

Inotropic

Digoxin Lanoxin, IV, PO Toxic and therapeutic doses may overlap;

Cardoxin Dobermans tend to be sensitive to digoxin
Generic Trade name(s) Route(s) Notes

Dobutamine Dobutrex IV infusion Use diluted solutions within 24 hr

Pimobendan Vetmedin PO Used to manage congestive heart failure; available

in Canada and Europe

Adrenergics

Epinephrine Adrenalin IV, IM, SC Available in several sizes for various uses

IT (intratracheal) 1:100 (1% or 10 mg/mL) topical, inhalation

IC (intracardiac) 1:1000 (0.1% or 1 mg/mL) IV, IM, SC, IT

Inhalation 1:10,000 (0.01% or 0.1 mg/mL) IV, IC

Isoproterenol Isuprel IV (infusion), rectal, Do not use with epinephrine

sublingual

Dopamine Intropin IV (infusion) Effects are dose dependent

Anticholinergics
Generic Trade name(s) Route(s) Notes

Atropine Many IV, IM, SC Used for cardiac support

Glycopyrrolate Robinul-V IV, IM, SC Used for cardiac support; not suitable for
emergency use

Beta Blockers

Atenolol Tenormin PO Sympathomimetic drug effects

Propranolol Inderal IV (slow), PO Can be blocked by beta agonists

Metoprolol Lopressor, PO Similar to propranolol, safer for patients with

Toprol bronchoconstriction

Esmolol Brevibloc IV Short-term treatment of supraventricular

tachycardia

Calcium Channel Blockers

Amlodipine Norvasc PO Use cautiously in animals with heart failure

Diltiazem Cardizem PO Toxicity may be treated with calcium infusion

Generic Trade name(s) Route(s) Notes

Verapamil Isoptin IV High first-pass effect; watch for toxicity in animals

with hepatic disease

Angiotensin-Converting Enzyme Inhibitors

Benazapril Lotensin PO For adjunctive treatment of heart failure

Captopril Capoten PO Use cautiously in animals with renal disease

Enalapril Enacard, Vasotec IV, PO Give on an empty stomach

Lisinopril Prinivil, Zestril PO Can be given once daily

Vasodilators

Hydralazine Apresoline IM, PO Use cautiously in patients with severe renal

disease

Nitroglycerin Nitro-Bid, Nitrol Topical Wear gloves when applying ointment

Nitroprusside Nitropress IV infusion Adverse effects are due to drugs hypotensive

effects
Generic Trade name(s) Route(s) Notes

Prazosin Minipress PO Also used to treat functional urethral obstruction

Antiarrhythmics

Lidocaine Xylocaine IV Do not use lidocaine with epinephrine

preparations for intravenous solutions

Procainamide Pronestyl, IV, IM, PO Use with caution with other antiarrhythmics
Procan

Quinidine Quinidex IV, IM, PO Use with caution with other antiarrhythmics

Diuretics

Furosemide Lasix, Disal, IV, IM, PO Veterinary preparations are normally slightly
Diuride, yellow; if human preparations turn yellow,
Salix do not use

Spironolactone Aldactone PO Potassium-sparing diuretic

Chlorothiazide, Diuril, PO Thiazide diuretics

hydrochlorothiazide Hydrodiuril

Mannitol Osmitrol, IV infusion Primary use is to decrease intracranial pressure

Mannitrol
Generic Trade name(s) Route(s) Notes

Anticoagulants

Heparin Many SC Used in disseminated intravascular coagulation

and in IV flush solutions

Dalteparin, enoxaparin Fragmin, SC Low-molecular-weight heparin used to prevent

Lovenox thromboembolisms
IC, Intracardiac; IM, intramuscular; IV, intravenous; IT, intratracheal; PO, oral; SC, subcutaneous.
I. Antiarrhythmics
A. When arrhythmias occur in the heart, antiarrhythmics restore normal electrical activity
B. Drugs that work by controlling Na flow include lidocaine and procainamide
+

C. Drugs such as propranolol, a negative inotrope, work by blocking beta receptors

D. Verapamil and diltiazem are calcium channel blocker antiarrhythmics
II. Diuretics
A. Furosemide and mannitol are examples of diuretics
B. Diuretics create an osmotic force in the renal tubules, thus drawing in water and increasing
urine output
1. Removing water decreases cardiac workload
2. Use cautiously in hypovolemic or hypotensive animals
III. Positive inotropes and catecholamines
A. These drugs increase the strength of contraction of the heart
1. Positive inotropes, such as digoxin, are used for long-term maintenance of
contractility by increasing the amount of calcium available in the heart
2. Catecholamines, such as epinephrine and dobutamine, are used for management of
short-term increased contractility; they act by mimicking the sympathetic nervous
system (adrenergics)
IV. Vasodilators
A. Nitroglycerin, hydralazine, and enalapril are vasodilators
B. Vasodilators cause an expansion in the diameter of blood vessels
1. This increase in diameter allows blood to flow more easily, which in turn reduces the
workload of the heart
V. Other cardiac drugs
A. Aspirin helps reduce the formation of blood clots
B. Bronchodilators enable the animal to increase oxygen intake
C. Sedatives can calm anxious patients, especially those having trouble breathing
D. Oxygen is almost always an indicated treatment for patients with cardiac disease, but as
with all drugs, it can be toxic in excess

RESPIRATORY DRUGS
I. Antitussives, such as butorphanol and hydrocodone, are mild opioids that suppress the cough reflex
(Table 19-5)
A. These drugs are indicated only for patients with a hacking, unproductive cough; dogs with
infectious tracheobronchitis (kennel cough) may be treated with cough suppressants
B. Antitussives may be contraindicated with productive coughs because of the risk for
accumulation of mucus and debris in the airways

TABLE 19-5
Respiratory Drugs

Generic Trade name(s) Route(s) Notes

Bronchodilators
Generic Trade name(s) Route(s) Notes

Albuterol Ventolin, PO, inhalation Most adverse effects are dose related and generally
Proventil transient

Terbutaline Brethine SC, PO,

inhalatio
n

Metaproterenol Alupent PO, inhalation

Aminophylline Many IV, IM Do not inject air into multidose vials; carbon dioxide
(painful), causes drug to precipitate; narrow therapeutic
PO index

Theophylline IV, IM, PO Available in sustained-release oral dose form

Inhaled Steroids

Fluticasone Flovent MDI Use a spacer for administration

Beclomethasone Vanceril, QVAR MDI Use a spacer for administration

Antihistamines

Chlorpheniramine Many PO Do not allow time-released capsules to dissolve before

Generic Trade name(s) Route(s) Notes

oral administration

Cyproheptadine Periactin PO Also used for appetite stimulation in cat

Diphenhydramine Benadryl IV, IM, PO Intravenous form used to counteract anaphylactic

reactions

Hydroxyzine Atarax PO All antihistamines may cause sedation

Clemastine Tavist PO Do not use the over-the-counter product Tavist-D

Trimeprazine (with Temaril-P PO Combination antihistamine and corticosteroid

prednisolone)

Zafirlukast Accolate PO Leukotriene receptor antagonist used to treat atopic

respiratory disease in cats

Cetirizine Zyrtec PO Useful for atopic dermatitis in dogs, eosinophilic

granuloma in cats

Antitussives

Butorphanol Torbutrol, IV, IM, SC, PO Opioid cough suppressant

Generic Trade name(s) Route(s) Notes

Torbugesic

Codeine Many PO Cough syrups containing codeine are usually

combination drug products

Hydrocodone Hycodan, PO Narcotic cough suppressant

Tussigon

Dextromethorphan Robitussin PO Nonnarcotic cough suppressant; available over the

counter

Decongestants

Phenylpropanolamine Propagest, PO Most common use in veterinary medicine is to treat

Proin urinary incontinence

Mucolytics

Acetylcysteine Mucomyst IV, PO, Also antidote for acetaminophen toxicity

inhalatio
n

Stimulants

Doxapram Dopram, IV, SC, SL Use in newborn resuscitation is controversial

Generic Trade name(s) Route(s) Notes

Respiram
IM, Intramuscular; IV, intravenous; MDI, multidose inhaler; PO, oral; SC, subcutaneous; SL, sublingual.
II. Expectorants increase the fluidity of respiratory mucus, making it easier to expel; mucolytics break
up mucus, decreasing its viscosity
A. Guaifenesin is available in OTC cough medications
1. Human OTC expectorants are of little benefit to animal patients
B. Acetylcysteine is a mucolytic that is often administered by nebulization
C. Humidification of inspired air can also increase mucus fluidity
III. Bronchodilators expand the bronchioles in the lungs, making it easier to breathe
A. Terbutaline, albuterol, and metaproterenol stimulate beta-2 receptors in the lung, which in
turn cause bronchodilation
B. Theophylline and aminophylline cause relaxation of smooth muscles in the lungs and, in
turn, bronchodilation
IV. Other drugs used to treat respiratory problems include antihistamines, corticosteroids, diuretics,
and oxygen
A. Antihistamines also cause bronchodilation if given prophylactically, by preventing histamine
from affecting the respiratory tract
B. Corticosteroids are given when inflammation of the airways is severe
C. Diuretics help to remove fluid from the lungs
D. Oxygen administration is indicated whenever perfusion is compromised

GASTROINTESTINAL DRUGS
I. Emetics cause vomiting (Table 19-6)
A. Used when noncaustic poisons are eaten or to empty the stomach before anesthesia
B. Some emetics act locally (cause irritation to the GI tract), such as syrup of ipecac and
hydrogen peroxide, and others act centrally (stimulate vomiting center in central nervous
system), such as apomorphine

TABLE 19-6
Gastrointestinal Drugs

Generic Trade name(s) Route(s) Notes

Antiemetics

Chlorpromazine Thorazine IV, IM, PO, Protect from light; may discolor urine to pink or red-
rectal brown

Dimenhydrinate Dramamine PO Used primarily for motion sickness

Generic Trade name(s) Route(s) Notes

Dolasetron Anzemet IV, IM, SC Similar to ondansetron with once-daily dosing

Meclizine Antivert PO Primarily used for motion sickness

Metoclopramide Reglan IV (slow), IM, Promotility agent; inhibits gastroesophageal reflux

SC, PO

Ondansetron Zofran IV, PO Indicated for refractory vomiting, chemotherapy

sickness, and other hard to treat nausea

Prochlorperazine Compazine IM, SC, PO, Rectal suppositories available for at home use in
rectal vomiting animals

Maropitant citrate Cerenia SC, PO Labeled for motion sickness, intractable vomiting in
dogs. NK receptor antagonist labeled for
1

treatment and prevention of acute vomiting and

prevention of vomiting as result of motion
sickness

Antiulcer

Antacids Amphogel, PO Neutralize acid; can affect absorption rates of other

Maalox, oral medications
Basalgel,
Tums

Cimetidine Tagamet IV, IM (stings), Oral form available OTC; do not refrigerate injectable
Generic Trade name(s) Route(s) Notes

SC, PO form

Famotidine Pepcid IV, IM, SC, PO Oral form available OTC

Nizatidine Axid PO Similar to ranitidine with prokinetic activity

Ranitidine Zantac IV (slow), IM Reduces gastric acid output

(stings), SC,
PO

Sucralfate Carafate PO Forms a protective barrier at gastric ulcer site; give

30 min before other antacids

Misoprostol Cytotec PO May cause GI side effects such as diarrhea

Omeprazole Prilosec PO A proton-pump inhibitor, may affect absorption rates

of drugs requiring a low stomach pH

Appetite Stimulants

Cyproheptadine Periactin PO Appetite stimulation in cat; may take more than one
dose to be effective

Diazepam Valium IV Appetite stimulation in cats; effective immediately

after injection; dose is a fraction of that used for
Generic Trade name(s) Route(s) Notes

sedation

Oxazepam Serax PO Appetite stimulation in cats

Antispasmodics

Aminopentamide Centrine IM, SC, PO Hypomotility drug; if urine retention noted as a side
effect, discontinue

Stimulants

Metoclopramide Reglan IV (slow), IM, Do not use if GI obstruction is suspected

SC, PO

Cisapride PO Has been removed from U.S. market; used in

management of feline chronic constipation

Laxatives

Magnesium salts Milk of PO Hyperosmotic; holds water in GI tract and softens

Magnesia stool
Generic Trade name(s) Route(s) Notes

Bisacodyl Dulcolax PO, rectal Stimulant laxative

suppositor
y

Lactulose Enulose PO Hyperosmotic; also used to reduce blood ammonia

levels in hepatic disease

Docusate Colace, DSS PO, enema Stool softener; watch hydration status

Antidiarrheals

Diphenoxylate/atropine Lomotil PO Opiates reduce gut motility; a small amount of

atropine reduces other narcotic effects

Kaolin/pectin Kaopectate, K-P- PO Kaopectate also contains salicylates; use with caution
Sol in cats

Bismuth subsalicylate Pepto-Bismol PO May discolor the stool to black; use salicylates with
caution in cats

Emetics

Apomorphine IV, IM, SC, If vomiting does not occur with initial dose,
topically in subsequent doses are not likely to be effective and
conjunctiva may induce toxicity; wear gloves when handling
Generic Trade name(s) Route(s) Notes

Miscellaneous

Ursodiol Actigall PO Used to increase the flow of bile

S-Adenosyl-L- Denosyl PO Nutraceutical used as an adjunct to treatment of liver

Methionine (SAMe) disease

Pancreatic enzymes Viokase, PO Products contain lipase, amylase, protease; cats

Pancrezyme strongly dislike the taste of powder forms

Activated charcoal Toxiban, PO Adsorbent used to prevent absorption of toxic

Liquichar elements in the GI tract
GI, Gastrointestinal; IM, intramuscular; IV, intravenous; OTC, over the counter; PO, oral; SC, subcutaneous.
II. Antiemetics prevent or decrease vomiting; the choice of antiemetic depends on the cause of the
vomiting
A. Chlorpromazine, diphenhydramine, meclizine, and dimenhydrinate may be used when
vomiting is related to motion sickness or vestibular disturbance
B. Metoclopramide causes increased gastric motility
C. Aminopentamide is an antispasmodic
III. Antidiarrheals are used to control frequent loose stools
A. Diarrhea has various causes, and treatment depends on the cause
B. These drugs work by modifying intestinal motility, adsorbing enterotoxins, and preventing
intestinal hypersecretions
1. Mild opioids such as loperamide and diphenoxylate are often very effective
antidiarrheal agents
2. Antispasmodics, such as aminopentamide, are sometimes indicated
3. Protectants and adsorbents, such as bismuth, kaolin, pectin, and activated charcoal,
are generally benign and are sometimes recommended for home use
IV. Laxatives are used to relieve constipation and to clear the lower intestinal tract
A. Hyperosmotics, such as lactulose and magnesium hydroxide, draw water to the bowel,
where it softens the stool
1. Fleet enemas should NOT be used in cats
B. Bulk-producing agents (fiber) help to increase the water content of the stool and stimulate
peristalsis in the GI tract
C. Lubricants, such as mineral oil and petroleum jelly, make the passage of stool easier
D. Stool softeners (docusate) allow water to penetrate GI contents
V. Antacids increase gastric pH, reducing irritation
A. Systemic antacids block gastric acid production by one of several means
1. H-blockers, such as cimetidine, ranitidine, and famotidine, prevent the production of
hydrochloric acid
2. Omeprazole is a proton pump inhibitor that prevents hydrogen ions from being
pumped into the stomach
3. Misoprostol inhibits the release of hydrogen ions and stimulates production of
bicarbonate and mucus in the stomach
VI. Antiulcer medications are used to treat defects in the stomach lining
A. Nonsystemic antacids directly neutralize acid in the stomach; are usually salts of aluminum,
calcium, or magnesium (Maalox, Amphogel, Mylanta, etc.)
B. Sucralfate is a protectant that binds to the surface of gastric ulcers

ANTIPARASITIC DRUGS
I. Antiparasitics kill or inactivate internal and/or external parasites (Table 19-7)
A. They may be drugs or insecticides

TABLE 19-7
Antiparasitics
 Trade
Generic Route(s) Efficacy Notes
name(s)*

Ivermectin Ivomec, IM, SC, PO Effective against most Collies and similar breeds may be
Heartgar internal parasites sensitive to ivermectin; use
d Plus, except cestodes with caution and observe for
Iverheart and liver flukes; adverse reactions
Plus used as a
heartworm
preventive and
microfilaricide

Selamectin Revolution Topical Dog: adult and Safe for ivermectin-sensitive

developing fleas, collies
heartworms, ear
mites, sarcoptic
mange
Cat: also controls
hookworm and
roundworms

Moxidectin Proheart, SC, topical Heartworm preventive Injectable has been removed from
Advantag the U.S. market indefinitely
e Multi

Milbemycin oxime Interceptor, PO Heartworm preventive May cause shocklike reaction in

Sentinel also effective dogs with large numbers of
against microfilaria
hookworms,
roundworms, and
whipworms

Lufenuron Program, SC, PO Interrupts flea life cycle Inhibits chitin production; does
Sentinel not kill adult fleas

Nitenpyram Capstar PO Adult fleas Kills 98% of adult fleas on pet

within 6 hr of
administration and for about
 Trade
Generic Route(s) Efficacy Notes
name(s)*

24 hr

Spinosad Comfortis, PO Adult fleas Oral flea adulticide for dogs;

Trifexis given monthly

Fipronil Frontline Topical Adult fleas and ticks Transient irritation may occur at
site of spot-on administration

Imidacloprid Advantage, Topical Adult fleas Advantage may be used weekly

Advantag for severe infestations
e Multi

Pyrethrins Many insect Topical Insects Neurotoxin insecticide; many

(permethrin) sprays permethrin toxicity cases in
and OTC cats are due to inappropriate
flea/tick application
spot-ons

Organophosphates Many (home PO, topical Many internal and Use of or exposure to more than
and yard, external parasites one organophosphate at a
area, and time greatly increases the
pet possibility of toxicity; signs
products) of toxicity include salivation,
lacrimation, urination,
defecation, dyspnea, and
emesis

Amitraz Mitaban, Topical Demodex mites, other Avoid contact with skin; avoid
Preventic ectoparasites breathing fumes; can be toxic
Collar, to cats and rabbits; may
Taktic, cause transient sedation and
ProMeris central nervous system
 Trade
Generic Route(s) Efficacy Notes
name(s)*

Duo depression, and may interact

with antidepressant
medications

Benzimidazole Panacur, PO Roundworms,

(mebendazole, Telmin, hookworms,
fenbendazole, Valbazen tapeworms (except
albendazole, etc.) Dipylidium
caninum), some
lungworms, large
and small
strongyles

Epsiprantel Cestex PO Tapeworms

Metronidazole Flagyl IV, PO Antiprotozoal See Table 19-1

Piperazine Pipa-Tabs PO Roundworms

(OTC)

Praziquantel Droncit, IM/SC (stings), Tapeworms

Drontal PO
Plus

Pyrantel Nemex, PO Roundworms, Piperazine antagonizes the effects

Strongid, hookworms of pyrantel
Heartgar
d Plus,
Iverheart
Plus
 Trade
Generic Route(s) Efficacy Notes
name(s)*

Melarsomine Immiticide IM only (stings) Heartworm adulticide Swelling at injection site common;
posttreatment
thromboembolism is possible
with adulticide therapy;
minimize activity after
treatment to reduce this risk

Methoprene (precor), Adams, Topical, Fleas Insect growth regulators are

nylar, fenoxycarb Defend, environme added to many flea control
Ectokyl, ntal products; interrupt flea life
ProTICall application cycle
, s
Knockout

Metaflumizone ProMeris, Topical Fleas Reported to be effective up to 6

ProMeris wks
Duo

Indoxacarb Activyl Topical Fleas Indoxacarb enters the flea by

contact or ingestion and is
converted by enzymes in the
flea to an active highly
insecticidal metabolite. Fleas
stop feeding, become
paralyzed and die within
hours

Dinotefuran Vectra Topical Fleas, mosquitoes Vectra for dogs contains

permethrin for efficacy
against ticks
IM, Intramuscular; IV, intravenous; OTC, over the counter; PO, oral; SC, subcutaneous.
*
Of products containing this ingredient. Many antiparasitics are combination formulas that may contain two or more drugs.
II. Rotating the antiparasitic used can help prevent parasite resistance

HORMONES AND ENDOCRINE DRUGS

I. Most reproductive drugs are hormones; these include the estrogens, progestins, prostaglandins, and
oxytocin (Table 19-8)
A. Estrogens
1. May be used after mismating to prevent pregnancy
2. Interfere with ova by not letting them reach the uterus
3. Aplastic anemia is one of many rare but serious side effects
B. Progestins
1. Used for estrous cycle regulation
a. If a mare is in transitional anestrus, progestins can return the animal to
proestrus
b. If an animal is in proestrus, progestins can prevent estrus
2. Liquid progestins can be absorbed through the skin; technicians should use caution
and wear gloves when preparing and administering
C. Prostaglandins
1. Lyse the corpus luteum
a. Can initiate a new estrous cycle for animals in diestrus
b. May cause abortion in pregnant animals and humans
2. Prostaglandins are easily absorbed through skin; use caution and wear protective
apparel
a. See MSDS or package insert for handling precautions
D. Oxytocin
1. Causes uterine contraction and milk letdown
2. Contraindicated if cervix is not dilated

TABLE 19-8
Hormones and Other Endocrine Drugs

Trade
Generic Route(s) Notes
name(s)

Estrogens

Estradiol ECP IM Primarily used to induce estrus; prevents pregnancy after

mismating in dogs and cats (rare use); toxic to bone
marrow; contraindicated in pregnancy
 Trade
Generic Route(s) Notes
name(s)

Diethylstilbestrol (DES) PO Used to treat estrogen-responsive urinary incontinence and

other conditions in dogs and cats; toxic to bone marrow;
contraindicated in pregnancy; banned in food animals

Progestins

Megestrol Ovaban, PO For false pregnancy, control of estrous cycle; contraindicated

Megace in pregnancy; can induce hypoadrenocorticism,
personality changes, transient diabetes, and many other
possible side effects

Altrenogest Regu-Mate PO Used primarily in horses to synchronize estrus or maintain

pregnancy; many handling warnings

Medroxyprogesterone Depo- IM, SC, PO Used in treatment of some behavioral and dermatologic
Provera conditions; many side effects

Androgens

Testosterone IM, SC Testosterone products are now Class III controlled substances
with limited use in veterinary medicine

Mibolerone Cheque PO Prevention of estrus and treatment of pseudocyesis in adult

Drops dogs; not recommended for cats

Prostaglandins
 Trade
Generic Route(s) Notes
name(s)

Dinoprost Lutalyse SC Causes uterine contents to be expelled; pregnant women and

asthmatics should handle only with extreme caution

Fluprostenol Equimate SC For large animal use

Cloprostenol Estrumate SC For large animal use

Pituitary Hormones

Desmopressin DDAVP SC, intranasal An antidiuretic hormone used in control of diabetes insipidus

Oxytocin Pitocin IV, IM, SC Induction/enhancement of uterine contractions at parturition

Corticotropin Cortrosyn IV, IM Used in the adrenocorticotropic hormone stimulation test

Vasopressin Pitressin IM Hormone used in diagnosis and treatment of diabetes

(diagnosti insipidus; recent use in refractory shock and in CPCR
c), IV
(CPCR)

Steroids
 Trade
Generic Route(s) Notes
name(s)

Fludrocortisone Florinef PO Mineralocorticoid for treatment of hypoadrenocorticism

Desoxycorticosterone Percorten-V IM Mineralocorticoid for treatment of hypoadrenocorticism

(DOCP)

Stanozolol Winstrol PO Anabolic steroid; rarely used; controlled substance in United

States

Nandrolone Deca- IM Anabolic steroid; rarely used; controlled substance in United

Durabo States
lin

Steroid Inhibitors

Mitotane, trilostane Lysodren, PO For treatment of pituitary-dependent hyperadrenocorticism;

Vetoryl trilostane must be imported into United States

Selegiline (L-deprenyl) Anipryl, PO For treatment of hyperadrenocorticism; also used in the

Eldepry treatment of canine cognitive dysfunction
l

Antidiabetics
 Trade
Generic Route(s) Notes
name(s)

Insulin Many SC Store in refrigerator; mix gentlydo not shake before using;
clients should be given thorough instructions on
the use of insulin

Glipizide, glyburide Glucotrol, PO Oral hypoglycemic agents

Micron
ase

Drugs Affecting Thyroid Hormone

Levothyroxine Soloxine, PO T thyroid hormone supplement

4

Thyrozi
ne

Liothyronine Cytobin PO T hormone supplement; may be useful in hypothyroid cases

3

that do not respond to T 4

Methimazole Tapazole PO Used in the medical management of hyperthyroidism

CPCR, Cardiopulmonary resuscitation; IM, intramuscular; IV, intravenous; PO, oral; SC, subcutaneous.
II. Examples of commonly used endocrine drugs are insulin and thyroid supplements
A. Insulin
1. Insulin is measured as international units (IU) per milliliter
2. Only insulin syringes should be used to measure insulin
3. Each mark on an insulin syringe is equal to 1 IU
4. Insulin is available in U-100 and U-40 concentrations
a. Each concentration has its own syringe type that must be used to measure
that particular concentration. If U-100 insulin is measured in a U-40 syringe,
the animal will receive an overdose that is 2.5 times the desired dose
5. Insulin removes glucose from circulation and stores it in tissues
6. Insulin is available in four forms
a. Regular insulin (short acting) is used when a rapid drop in blood sugar is
needed; it can be administered intravenously, unlike other insulins
b. Neutral Protamine Hagedorn (NPH) insulin (intermediate acting) is used to
control diabetes mellitus on a daily basis
c. Protamine zinc insulin (long acting) is used in animals, usually cats, that
need a slower release of insulin to carry them through 24 hours
d. Glargine and detemir insulin are long acting and relatively peakless in
contrast to other insulins
B. Thyroid medications
1. The pituitary gland secretes thyroid-stimulating hormone, which tells the thyroid
gland to produce and secrete the hormones triiodothyronine (T ) and thyroxine (T )
3 4

2. These hormones regulate the metabolic rate for the rest of the body
3. Two common conditions associated with the thyroid gland are hypothyroidism
(usually seen in dogs) and hyperthyroidism (usually seen in cats)
4. Hypothyroidism occurs when thyroid function is decreased
a. This can happen when the thyroid gland is diseased (primary
hypothyroidism) or when the pituitary gland is diseased (secondary
hypothyroidism)
b. Hypothyroidism slows metabolic processes
c. Thyroid supplementation is the treatment of choice for hypothyroidism
d. Synthetic T , synthetic T , and thyroid extract are the supplementation
3 4

choices available
(1) Thyroid extract is highly variable in its effectiveness
(2) Oversupplementation is common with T administration 3

(3) T supplements are usually indicated in animals

4

5. Hyperthyroidism occurs when thyroid function is increased, thus speeding up

metabolic processes
a. Thyroidectomy is usually an option for hyperthyroid treatment
b. Two other courses of treatment are also available
(1) Methimazole (Tapazole), which interferes with the production of T 3

and T 4

(2) Introduction of radioactive iodine, which is taken up by the

thyroid gland and destroys any tumor cells (and most of the normal
thyroid cells) that are present

IMMUNOLOGICAL DRUGS
See Table 19-9. Also see Chapter 9
TABLE 19-9
Chemotherapeutic and Immunological Agents

Generic Trade Name(s) Route(s) Toxicity/Notes

Alkylating Agents

Carboplatin Paraplatin IV Bone marrow, GI

Cisplatin Platinol IV Bone marrow, GI; do not use in cats

Chlorambucil Leukeran PO Bone marrow, GI

Cyclophosphamide Cytoxan IV, PO Bone marrow, GI, hemorrhagic cystitis

Dacarbazine DTIC-Dome IV GI; do not use in cats

Lomustine CCNU, Ceenu PO Bone marrow, GI, hepatopathy

Antimetabolites

Cytarbarine Cytosar-U IV, SC Bone marrow, GI

Methotrexate IV, PO Bone marrow, GI, renal

Generic Trade Name(s) Route(s) Toxicity/Notes

5-Fluorouracil IV Bone marrow, GI, CNS; do not use in cats

Antibiotics

Doxorubicin Adriamycin IV Bone marrow, GI, cardiac, urticaria, alopecia,

vesicant

Mitotic Inhibitors

Vincristine Oncovin IV GI, peripheral nervous system, vesicant; skin

contact causes irritation

Vinblastine Velban IV Bone marrow, GI, alopecia; vesicant; skin contact

causes irritation

Miscellaneous Chemotherapeutics

Asparaginase Elspar IV, SC Anaphylaxis, coagulation disorder

Hydroxyurea Hydrea PO Bone marrow, GI, alopecia, dysuria

Mitoxantrone Novantrone IV Bone marrow, GI

Generic Trade Name(s) Route(s) Toxicity/Notes

Piroxicam Feldene PO GI ulceration

Immunosuppressants

Azathioprine Imuran PO Bone marrow, immunosuppression

Cyclophosphamide See above

Cyclosporine Sandimmune, Ophthalmic, Used for immune suppression, treatment of

Neoral, Atopica PO atopy, and stimulation of tear production

Corticosteroids See Table 19-2

Metronidazole See Table 19-1

Immunostimulants

Acemannan Aloe vera derived

Staphylococcus phage lysate SPL Lethargy, fever, chills, injection site irritation;
used in treatment of pyoderma
Generic Trade Name(s) Route(s) Toxicity/Notes

Propionibacterium acnes Immunoregulin IV Lethargy, fever, chills

Mycobacterium cell wall Regressin Intratumor Fever, lethargy

fraction

Interferon alpha-2a (human), Roferon, Virbagen SC, PO Feline interferon not yet available in United States
omega (feline) Omega, Trental

Others

Pentoxifylline PO GI, CNS; used in treatment of immune-mediated

dermatosis (dogs), endotoxemia and
navicular disease (horses)

Erythropoietin Epogen, Procrit SC Autoantibody formation may limit usefulness in

treatment of nonregenerative anemia

Filgrastim (granulocyte Neupogen SC Autoantibody formation and immune response to

colony-stimulating human DNA-origin drug may worsen
factor) neutropenia
CNS, Central nervous system; GI, gastrointestinal; IV, intravenous; PO, oral; SC, subcutaneous.
I. The sheer number of vaccines available to induce active immunity limits their discussion in this
chapter to general characteristics
A. Vaccines are used to prevent disease or to reduce the virulence of diseases that animals may
contract
1. Vaccines cannot cure a disease process that is present before vaccination
B. Vaccines stimulate an animals immune system by introducing an antigen derived from
pathogenic agents and encouraging an anamnestic response
1. Vaccines are described as live, modified live, or killed
2. Killed vaccines are safest but tend to be less effective than the other forms
3. Modified live and live vaccines tend to be more effective, but are also more likely to
induce disease and may be dangerous to pregnant animals
C. Vaccines are available in many forms, including injections, intranasal solutions, powdered
feed additives, aerosol sprays, and water additives
D. Vaccine efficacy depends on several factors, including dose given, route of administration,
age of animal, storage conditions, health and immune status of animal, and breed and species
of animal
E. It is not known when passive immunity via maternal antibodies ceases to protect neonates;
therefore multiple doses of vaccine are required at regular intervals to optimize protection for
young animals
F. Most vaccines are not effective immediately after administration
1. Some take 2 weeks or more to reach maximum efficacy
G. Warming vaccines just before use reduces pain of administration
II. Vaccines that produce passive immunity by providing the animal with a short-term supply of ready-
made antibodies come in two basic forms
A. Antitoxins contain antibodies to specific toxins (e.g., Clostridium, Tetanus)
B. Antiserums contain antibodies to specific microorganisms (e.g., Escherichia coli, Salmonella)
III. Drugs such as acemannan (derived from aloe vera), staphage lysate, and immunoregulin may help
stimulate the immune system in certain conditions
IV. Immunosuppressants are used to treat diseases in which the animals immune system is
responding inappropriately
A. Drugs such as azathioprine, cyclosporine, cyclophosphamide, and corticosteroids are used
for various immunosuppressive effects

TOPICAL DRUGS
I. Topical drugs are applied to the skin surface, including mucous membranes, and may be
administered into or onto the ear, eye, nose, mouth, prepuce, or vulva
A. Generally, topical drugs are not absorbed well systemically
1. Drugs labeled for transdermal (TD) or transmucosal (TM) administration are
formulated for systemic absorption
B. Because veterinary patients tend to lick their wounds, read package instructions carefully
1. Extra caution is warranted when using human products, because they are more
likely to be toxic if consumed
C. Wear proper protective clothing when applying topical drugs that are meant to be absorbed
systemically (e.g., nitroglycerin and pour-on preparations)
II. Ophthalmic agents are usually in drop or ointment form and may require multiple applications to be
effective. Read the package inserts and advise clients accordingly
A. Mydriatics, such as atropine, are used to dilate the pupil
 1. Tropicamide is a rapidly acting mydriatic used in the veterinary hospital to prepare a
patient for ocular fundus examination
B. Miotics, such as pilocarpine, cause pupillary constriction
C. Several drugs are used to reduce intraocular pressure; they work by either reducing aqueous
humor production or having a diuretic effect on the eye
D. Proparacaine and tetracaine are ophthalmic anesthetics
E. Cyclosporine stimulates increased tear production
F. There are numerous ophthalmic antiinfective agents and antiinflammatory agents
1. Preparations containing steroids should NOT be used if a corneal ulcer could be
present
III. Otic preparations are most often either antiinfective (antibacterial, antifungal, antiparasitic),
antiinflammatory, or both
A. Many of these drugs should NOT be used in the presence of a ruptured eardrum, so an
examination is necessary before they can be dispensed
B. Many are also ineffective in the presence of debris, so the ear canals must be cleaned before
medications are used
IV. Drugs used on the skin come in several forms
A. Shampoos, conditioners, and sprays
B. Wound-healing agents, such as cleansers, protectants, and healing stimulators

CHEMOTHERAPEUTIC DRUGS
I. Antineoplastic agents kill cells (see Table 19-9). They do not discriminate between good cells
and bad cells, or between animal cells and human cells. Therefore it is extremely important to
wear protective clothing when administering or preparing these agents
A. Consult the MSDS, package insert, and hospital procedures manual for information about
the safe handling of chemotherapeutic drugs
B. These drugs target rapidly dividing cells, such as those in tumors, bone marrow, GI tract, and
reproductive tract
1. They can cause permanent alterations to DNA
C. Doses are administered according to body surface (measured in meters squared, not body
weight)
D. There are five basic types of antineoplastic drugs: alkylating agents, antimetabolites, plant
alkaloids, antibiotics, and hormonal agents
1. Chemotherapy is often a scheduled combination or alternation of two or more of
these agents, depending on the cancer type and stage
2. This complicated treatment system is often best left to cancer specialists
II. Hematinics are substances that promote an increase in the oxygen-carrying capacity of the blood
A. Iron, copper, and B vitamins support the formation of hemoglobin
B. Erythropoietin is a growth hormone produced by the kidneys that stimulates red blood cell
production
1. A synthetic form is available for injection
C. Androgens (anabolic steroids), although rarely used because of the problems associated with
them, may be beneficial in treating certain chronic anemias
D. Blood substitutes, such as Oxyglobin, can increase oxygen-carrying capacity temporarily
while the body grows new red blood cells
III. Anticoagulants, such as heparin and coumarin derivatives, are sometimes used to treat thrombotic
disease in vivo, but anticoagulants in general are more commonly used to preserve blood samples in
vitro
 IV. Thrombolytics, such as streptokinase, have largely proved minimally effective and cost-prohibitive in
the treatment of thromboembolic disease in animals

ANTIDOTES AND REVERAL AGENTS

See Table 19-10.

TABLE 19-10
Antidotes and Reversal Agents

Generic Trade name(s) Uses/Indications

Acetylcysteine Mucomyst Acetaminophen toxicity

Antivenin (Crotalidae) polyvalent Antivenin Poisonous snake envenomation (United States)

Atipamezole Antisedan Reversal of dexmedetomidine (Dexdomitor)

Atropine Many Organophosphate toxicity

Calcium EDTA Calcium disodium Lead poisoning

versenate

Crotalidae polyvalent immune FAB Crofab Crotalid snake envenomation

(ovine)

Cyproheptadine Periactin Serotonin syndrome (selective serotonin reuptake

inhibitor toxicity)

Dantrolene Dantrium Malignant hyperthermia

Generic Trade name(s) Uses/Indications

Dimercaprol BAL in Oil Arsenic, lead, mercury, gold toxicity

Ethanol Many Ethylene glycol toxicity

Flumazenil Romazicon Reversal of benzodiazepines (Valium)

Fomepizole (4-MP) Antizol-Vet Ethylene glycol toxicity

Methylene blue Urolene Blue Nitrate, chlorate toxicity in ruminants

Naloxone Narcan Opioid agonist reversal

Pamidronate Aredia Cholecalciferol toxicosis

Neostigmine Stiglyn Neuromuscular-blocking agent toxicity (pancuronium,

succinylcholine)

Penicillamine Cuprimine Lead, copper toxicity

Pralidoxime (2-PAM) Protopam Organophosphate toxicity

Yohimbine Yobine Reversal of xylazine (Rompun)

Generic Trade name(s) Uses/Indications

NUTRACEUTICALS
I. The North American Veterinary Nutraceutical Council defines a veterinary nutraceutical as a non-
drug substance that is produced in a purified or extracted form and administered orally to provide
agents required for normal body structure and function with the intent of improving the health and
well-being of animals" (Boothe, 1997) (Table 19-11)
A. These products require neither food safety nor drug safety and efficacy testing by FDA.
There is very little information about safety, efficacy, purity, dosing, side effects, or adverse
effects of most of these products
B. Species differences and individual variation affects an animals physiological response
C. Investigate individual products and manufacturers independently before using or
recommending them

TABLE 19-11
Nutraceuticals

Generic Examples Uses/Indications Warnings

Antioxidants Vitamin E, vitamin C, Protection from free radical

selenium, superoxide associated oxidative cell and
dismutase (SOD) tissue damage

Echinacea Purple coneflower Immunomodulation by stimulation of Does not replace

phagocytosis antimicrobial
therapy

Fatty acids Essential fatty acids (EFA)- High doses of omega 3 may be anti- High doses of EFA may
omega 6 Polyunsaturated inflammatory; may also be be proinflammatory
fatty acids (PUFA)-omega useful for brain development, and inhibit platelet
3 skin health, renal protection, and function. Products
reduction of cartilage loss in highly susceptible to
osteoarthritis rancidity
Generic Examples Uses/Indications Warnings

Garlic Many Thought to increase circulation, Moderate amounts can

support liver and immune be toxic to dogs and
system, and have antimicrobial even small amounts
and antioxidant properties. can cause hemolytic
anemia in cats

Ginger Many Antiemetic and digestive aid Large amounts can be

harmful to pregnant
animals and those
on anticoagulants

Chondroprotective Glucosamine, chondroitin, May help rebuild joint tissue and Products vary widely in
s SAM-e, fluid and delay further quality, as does
Methylsulfonylmethane degeneration individual response
(MSM) to them

L-lysine Viralys, Enisyl-F Interferes with arginine uptake by Very high doses given
herpes virus in replication; over long periods
reduces viral load and shedding may theoretically
in infected cats cause dietary
arginine deficiency

Milk thistle Denamarin Antioxidant, antiinflammatory, Very high doses can

(silymarin) antifibrotic effects, improves cause GI upset
hepatocyte stability and bile flow

Prebiotics Fructooligosaccharide (FOS), Provide fermentable nutrients for gut

arabinogalactan, manno- flora; create healthy GI tract
oligosaccharides (MOS), environment
lactulose, lactosucrose,
chicory

Probiotics Bifidobacterium, Lactobacillus, or Restore normal, healthy gut flora by Products are highly
Generic Examples Uses/Indications Warnings

Saccromyces spp., inoculation with living susceptible to decay

Enterococcus faecium organisms and death of
organisms; careful
handling and
storage is essential

Lactoferrin Microlactin, Duralactin Inhibits leukocyte migration and

participation in inflammatory
process

Enzymes Arginine Arginine helps regulate urea cycle,

Carnitine increases sensitivity to insulin,
Glutamine stimulates immune function,
tumor growth inhibition.
Carnitine improves efficiency of
energy metabolism. Glutamine
supports enterocyte structure
and function

Apoaequorin Neutricks Calcium blocker reduces

mitochondrial damage in CNS;
used to treat or prevent cognitive
dysfunction syndrome
SUMMARY
Pharmacology is an inexact science. Any given drug may affect different animal species, or even individual
animals within one species, unpredictably. Remember to treat each patient as an individual and pay attention
to any abnormal behavior displayed by an animal being treated with any pharmaceutical. Used correctly, drugs
are a great benefit to veterinary medicine; used incorrectly, they can be detrimental.

ACKNOWLEDGMENT
The editors and author recognize and appreciate the original work of Cathy Painter, on which this chapter is
based.

REVIEW QUESTIONS
1. Which of the following is not a veterinary technician responsibility?
a. Prescribing medications
b. Calculating medication doses
c. Administering medications
d. Observing effects of medications

2. Use of a drug in any manner other than its approved indicated use is called:
a. Compounding
b. Extra-label
c. Illegal
d. Prescribing

3. Which is not one of the five rights of medication administration?

a. Right patient
b. Right dose
c. Right time
d. Right concentration

4. The three checks technique is a method of ensuring that:

a. The correct patient receives medication
b. The correct dose of medication is administered
c. The correct medication is selected
d. The medication is labeled correctly

5. Antimicrobial drugs would be ineffective for which of the following types of organisms?
a. Bacteria
b. Fungus
c. Nematode
d. Yeast

6. Antimicrobial medications must be given:

a. As needed to control symptoms of infection
b. As prescribed by the veterinarian until gone
 c. Until the pet feels better
d. On a full stomach for proper absorption

7. Sulfa drugs work by:

a. Disrupting microbial metabolic activity
b. Preventing DNA synthesis
c. Damaging microbial cell membranes
d. Disrupting microbial protein synthesis

8. Opioid analgesics work by:

a. Blocking pain signals in the brain
b. Preventing pain signals from reaching the spinal cord
c. Reducing inflammation in the tissues
d. Anesthetizing the patient

9. Prednisone should not be given with:

a. Midazolam
b. Diphenhydramine
c. Famotidine
d. Meloxicam

10. Which of the following is a central nervous system stimulant?

a. Dopamine
b. Dobutamine
c. Dexmedetomidine
d. Doxapram

11. Antidepressant medications are used in animals to address:

a. Problem behaviors
b. Bipolar disorder
c. Chronic pain
d. Attention deficit disorder

12. Antiarrhythmic drugs work by:

a. Reestablishing normal electrical signals in the heart
b. Slowing transmission of nerve impulses in the brain
c. Regulating peristalsis of the intestine
d. Reducing skeletal muscle spasms

13. The drug given in cardiac arrest to jump start the heart is:
a. Atropine
b. Methylprednisolone
c. Sodium bicarbonate
d. Epinephrine

14. Which of the following is an antiemetic?

 a. Ranitidine
b. Chlorpromazine
c. Morphine
d. Amlodipine

15. Which of the following is an effective antidiarrheal medication?

a. NSAID
b. Stimulant
c. Hyperosmotic
d. Mild opioid

16. Hypothyroidism can be treated with:

a. Methimazole
b. Radioactive iodine
c. Thyroidectomy
d. T supplementation
4

17. Azathioprine is an:

a. Immunostimulant
b. Immunosuppressant
c. Antitoxin
d. Antiserum

18. Chemotherapeutic drugs are:

a. Selective for animal cells
b. Only effective against tumor cells
c. Effective against any dividing cells
d. Safe for healthy adults to handle

19. A nutraceutical is a:
a. Nutritional supplement
b. Drug
c. Food
d. Nutrient with a druglike effect

20. Probiotics and prebiotics are used to:

a. Reduce inflammation
b. Rebuild joint tissue
c. Support healthy gut flora
d. Treat infection
CHAPTER 2

Urinalysis and Hematology

URINALYSIS
A complete urinalysis includes the evaluation of the physical, chemical, solute, and microscopic components of
the urine and may include microbiological cultures and sensitivity testing, as well as identification of urinary
calculi.
I. The information gained from these evaluations is used to assess the urinary system and aid diagnosis
of nonurinary tract disorders
A. Whether searching for or confirming a diagnosis, screening for an asymptomatic disease
during an annual health or presurgical examination, monitoring the progress of a disease, or
assessing the efficacy and safety of a treatment, urinalysis helps in patient evaluation
1. Urine testing is usually easily performed, requiring a minimum of supplies,
diagnostic instrumentation, and veterinary technician time
B. Qualitative (and semi-quantitative) urine analysis
1. Outcome is not affected by rate of urine formation or amount produced during a
specific rate of time
2. Allows determination of excretion rate of various endogenous and exogenous
substances by volume collected, as well as time during which collection takes place
and condition of collection
C. Endogenous substances include uric acid, amino acids, hormones, and electrolytes
D. Exogenous substances are creatinine clearance and phenolsulfonphthalein dye
II. Quantitative urinalysis
A. Outcome is affected by volume collected, as well as time and condition(s) during collection

Specimen Collection and Handling

I. Containers
A. Collect the specimen in a clean (preferably sterile and disposable), dry, opaque container to
prevent contamination and degradation of the light-sensitive components (e.g., bilirubin and
urobilinogen)
1. The container should be non-breakable and fitted with a tight lid after collection, to
prevent contamination, spillage, or evaporation
2. Sterile containers should be used for urine samples collected by cystocentesis or
catheterization for bacterial culture
3. The sterile aspiration syringe used for these procedures makes an acceptable
container and should be immediately capped
B. Timing of urine formation versus collection versus analysis
1. Formation
a. Because urine is stored in the bladder after formation, the urine is not
necessarily fresh on collection
 b. Deterioration of components may have occurred from the natural
breakdown of formed elements, and may be influenced by the presence of
bacteria and change in pH
2. Collection
a. Fasted, postprandial, after rest, random versus timed, singular versus serial
b. A singular sample gives a snapshot in time, whereas a series of
samples provides a record of changes due to variation in activity
c. A post rest sample will likely be more concentrated than a sample collected
after activity and water consumption
d. A 3- to 6-hour postprandial sample may be more reflective of the diet
3. Analysis
a. Degradation occurs from the instant of formation and subsequent collection
b. To be reliable and best reflect the patients condition, a urinalysis should
be performed within 20 to 30 minutes of collection
c. Point-of-care testing (POCT) should be considered for increased accuracy
C. Methods of collection
1. Free flow (clean catch, spontaneous micturition or voiding)
a. Simple, noninvasive procedure but unsatisfactory for bacterial culture
b. Preferably, a midstream sample is collected, avoiding initial or end portion
of the voided urine
c. Vulva or prepuce should be cleansed before collection
d. Variations
(1) Commercially available absorbable urine sponges
(a) For chemistry and physical evaluation only
(b) Not for microscopic urinalysis
(2) Litter pan
(a) Replace regular absorbable litter with inert non-absorbable
litter
(3) Manual expression
(a) Must be performed with care and patience; avoid excessive
pressure to the bladder
(b) Should never be attempted on an animal with a suspected
urethral obstruction
(4) Metabolism cage
(a) Usually of value to determine urine volume only
(b) Extended time between collection and testing may increase
the possibility of contamination and sample degradation
(c) To assist in maintaining sample quality, cold pack collection
reservoirs are available, as are alarm-sensitive cages, which
alert personnel to the presence of a sample
(5) Tabletop, cage, floor
(a) May be adequate for screening if the surface is clean and
free of disinfectant residues, and the sample is analyzed in
an expedient manner such as POCT
(b) These samples are usually contaminated, not suitable for
bacterial culture, and offer limited diagnostic information
(6) Client-collected samples
(a) Usually, client-collected samples are not satisfactory
because of improper collection procedures, the extended
 time between collection and testing, and the use of improper
containers and storage
(b) Although not always practical, it is best to have the client
bring the patient to the clinic
(c) Under these circumstances, the client should be asked to
discourage the pet from voiding urine for 2 to 3 hours before
the appointment to facilitate collection at the clinic
2. Cystocentesis
a. Perform by inserting a needle through the ventral abdominal wall and into
the urinary bladder
b. Perform the procedure using aseptic technique on a patient with a full
bladder, thus providing a better anatomical reference and minimizing
possible damage to other abdominal organs
c. Collection through cystocentesis avoids contaminants from the lower
portions of the urinary tract, making the sample suitable for bacterial culture
3. Transurethral catheterization
a. Performed by passing a rubber, plastic, or metal catheter through the
urethra and into the urinary bladder
b. Type and size of catheter depends on size, gender, and species of animal
c. Catheterize as aseptically and atraumatically as possible to avoid
complications for the patient and catheter-induced cellular and bacterial
contamination of the sample
d. Sample is aspirated into a syringe attached to the exposed end of the
catheter
D. Preservation
1. For microscopic evaluation, centrifuge immediately
2. Refrigerate (~ 35 to 46 F [~ 2 to 8 C]) for an additional 2 to 12 hours if
necessary, but bring sample to room temperature (~ 68 to 77 F [~ 20 to
25 C]) before evaluation, especially if evaluating specific gravity (SG) and crystals
a. Cold urine may also interfere with enzymatic reactions on the urine
chemistry dipsticks
3. Freezing ( 32 F [ 0 C]) is satisfactory for common urine chemical
analytes, but will most likely destroy the cellular elements
4. Chemicals
a. The sample can be preserved by the addition of acidifiers (e.g., boric acid or
hydrochloric acid), formaldehyde, toluene, thymol, phenol, chloroform,
sodium fluoride, and commercial chemical urinary preservatives
b. Although one or more urine elements may be preserved by the chemical, it
may be at the expense of other elements in the urine
E. Sample variables
1. Samples should be analyzed within 20 to 30 minutes of collection to maximize
validity of information and minimize post collection analytical variables
2. One, more, or all results may be directly or indirectly influenced by non-pathological
internal and external influences (e.g., exercise, water intake, diet, medication,
collection method, degree of restraint, environmental factors [e.g., temperature,
humidity])
a. The veterinarian interprets individual test results in light of these variables,
with the results of other urine and clinical evaluation procedures, and in
concert with the physical examination and history
 3. Pre-collection and post-collection (pre-analytical), artifactual or iatrogenic
variables may increase or decrease values, resulting in false-positive or false-negative
results.
4. See Table 2-1 for variations that affect test results

TABLE 2-1
Variation to Deterioration of Sample and Influences on Test Methods

Component Variation

Ammonia Increase from proliferation of urease-producing bacteria

Bacteria Increase from the in vitro proliferation of bacteria that normally inhabit the vagina, labia, urethra, or
prepuce or arise from urinary tract infections or contamination from external sources
Bacterial concentration approximately doubles every hour at room temperature (~ 68-77 F
[~ 20-25 C])

Bilirubin Decrease from exposure to light and oxidation at room temperature

Casts Decrease due to alkalization (pH > 7.0) or dilution of urine (SG ~ < 1.008-1.010)

Color Darkens with exposure to light and urochrome degradation

Brown-black discoloration with blood substitutes

Crystals Types and numbers increase or decrease with pH and temperature changes (colder temperature causes
increase)

Erythrocytes Hemolysis caused by dilute and/or alkaline urine, or freezing

Glucose Decrease from metabolism by cells or bacteria and/or from the inhibition of the enzymatic reaction on the
Component Variation

chemistry strip if the urine is cold

Hemolysis Increases as a result of the deterioration of the erythrocytes in alkaline or dilute urine blood

Ketones May decrease with the presence of bacterial metabolism and volatilization of acetone

Leukocytes Decrease with alkalization and/or dilution of urine, or freezing

Nitrites Increase when bacteria convert nitrate to nitrite

Decrease when nitrite is converted to nitrogen and evaporates

Odor Becomes stronger from the ammonia produced from bacterial metabolism

pH Usually increases (alkaline) with the presence of urease-producing bacteria and/or the loss of carbon
dioxide
Decreases (acidic) with the proliferation of nonurease-producing bacteria and yeasts converting
glucose to acids

Proteins Increase from bacteria proliferation, alkalization, contamination with chemicals (e.g., disinfectants:
quaternary ammonium or chlorhexidine), some medications (check package insert), blood
substitutes, anesthetics, or elevated body temperature
Decrease with acidic urine

Turbidity Develops from presence of bacteria, proliferation of crystals, or precipitation of amorphous material
Component Variation

Somatic cells Deteriorate with rise in pH or freezing

Urobilinogen Decreases on exposure to light

Yeasts/fungi Increase from external contamination or resistant urinary tract infection

II. Physical evaluation

A. Terms related to urine volume and output
1. Anuria: complete absence of urine formation or elimination
a. Can occur from renal shutdown; usually associated with obstruction
2. Continence: storage of urine in the bladder as it fills
3. Dysuria: difficulty or pain on urination
4. Incontinence: dribbling of urine at frequent intervals
a. Commonly occurs in dogs because of congenital abnormality of the ureters
or urethra
5. Micturition: physiological term for emptying the bladder
a. Commonly referred to as urination
6. Oliguria: a decrease in the formation or elimination of urine
a. Occurs with shock, dehydration, water conservation, renal failure, and
insufficiency
7. Pollakiuria: refers to frequent urination
a. Often confused with polyuria by clients
8. Polyuria: formation and excretion of large volumes of urine
a. Associated with nephritis, diabetes mellitus, and polydipsia; may be an
unreliable symptom in itself
B. Volume: influenced by several factors, including water intake, environmental temperature,
physical activity, size, species, diet, and medications
C. Ideally, various sequential samples should be evaluated over 24 hours to determine the
various internal and external influences on urine volume and the other physical, chemical,
and microscopic analytes
D. Color
1. In most species, although urine is regarded as yellow, it may range in color
from pale to amber colored
a. Yellow is normally due to urochrome pigments
b. Urobilinogen may also influence the color
2. Color generally correlates with SG (concentration), volume, and pigments from
internal or external sources
a. Light-colored urine tends to have a lower SG; darker urine generally has a
higher SG
 b. Bile pigments are likely contained in yellow-brown to greenish urine that
foams when shaken
c. Red or reddish-brown urine indicates hematuria (red blood cells [RBCs]) or
hemoglobinuria (hemoglobin [Hb])
d. Brown urine may contain myoglobin from muscle cell breakdown
(myoglobinuria)
e. Medications and diet may influence color
f. Increase in urine volume results in urine dilution and lighter color
g. Urine collected after a period of rest tends to be darker in color because of
increased concentration
3. Some species have variable color of urine
a. Rabbit urine commonly varies from yellow to cloudy-white to orange-red-
brown due to porphyria pigments
b. Horse urine is browner on standing due to oxidation
E. Transparency (turbidity, cloudiness): presence of particulate matter
1. Transparency is described as clear, hazy, cloudy, turbid, opaque, or flocculent (large
particulate matter that readily settles out)
2. Cloudy urine can be associated with the presence of cellular debris, such as RBCs,
white blood cells (WBCs), epithelial cells, crystals, bacteria, casts, mucus, semen, and
lipids
a. Bacterial proliferation or crystal formation can cause urine to become cloudy
on standing
3. Normal freshly voided urine in many species is clear; exceptions include:
a. Horse, because of the presence of calcium carbonate crystals and mucus
secreted by glands in the renal pelvis
b. Rabbit, hamster, and guinea pig, because of the presence of calcium salts
c. Feline urine commonly is slightly cloudy, because of the presence of fat
d. On standing, urine typically becomes more cloudy with the increased
number of bacteria and possible formation of crystals (e.g., calcium
carbonate crystals form in cattle urine)
4. Microscopic evaluation is necessary to distinguish possible causes of turbidity
III. Odor
A. Not highly diagnostic; varies with species and gender of the patient
1. Odors are commonly described as
a. Normal (characteristic for the species and gender)
b. Ammoniacal (urease-producing bacteria)
c. Putrid (bacterial degradation of protein)
d. Fruity or sweet (e.g., ketones, glucose)
e. Disagreeable
2. Strong urine odor is typical in mice and intact male cats, goats, and pigs
3. In some cases, a sweet or fruity odor can indicate the presence of ketones (ketonuria)
and is commonly associated with diabetes mellitus, pregnancy toxemia in sheep, or
acetonemia (ketosis) in cows
4. Ammonia is due to bacterial proliferation, which may be from infectious or
contaminating organisms, and will result in increased odor on standing
a. It may be indicative of improper storage rather than the health of the patient
5. Odor may be influenced by diet and medications
IV. Specific gravity (SG, urine specific gravity [USG])
A. Density of a liquid compared with that of distilled water
 1. In practical applications, it is used to assess the ability of the renal tubule to
concentrate or dilute filtrates from the glomerulus, indicating how well the kidney can
maintain water and osmotic balance
2. The urine SG is interpreted by the veterinarian in concert with the patients
hydration status, and blood urea nitrogen and serum creatinine levels
3. Urine density decreases as temperatures increases
4. Urine temperature is a factor when measuring SG
B. Terms related to SG
1. -sthen (strength), iso- (the same as), hypo- (less than), hyper- (greater than)
2. Isosthenuria (fixed SG [SG ~ 1.008 to 1.012])
a. The glomerular filtrate has the same SG as the plasma. The urine has been
neither diluted nor concentrated in the renal tubules
3. Hyposthenuria (SG < ~ 1.008)
a. Tubules are diluting the urine below the SG of plasma
b. Osmolality measurement is less than that of plasma
4. Hypersthenuria (baruria [SG > ~ 1.012])
a. Tubules are concentrating the urine above the SG of plasma
b. Osmolality measurement is more than that of plasma
5. Maximum urine concentration (SG) values
a. Species-specific maximum concentration capacity of the tubules
6. Functionally adequate urine concentration (SG) values
a. Species-specific sufficient concentrating ability, suggesting a sufficient
number of normally functioning nephrons to prevent azotemia
(presence of nitrogen wastes [e.g., urea, creatinine] in the blood) assuming
renal blood flow is sufficient and there are no other influencing factors to
impair the function of the nephrons
7. Inappropriate urine concentration (SG) values
a. Values below the questionable range
8. Questionable SG values
a. Values marginally below the functionally adequate range
C. Normal (reference) SG values vary and fluctuate widely from day to day and within the
same day and are related to the individual, species, diet, activity, water, and electrolyte
balance of the body, as well as possible pathologies
1. A single value within the normal or outside the normal range for an individual or
the species does not necessarily reflect renal function or dysfunction
D. Methods of SG evaluation
1. Refractometer (total solids [TS] meter)
a. Solute in the urine bends light passing through the urine to a degree that is
proportional to the concentration of the solute
b. Approximately measures SG or total solids of urine
c. Refractometers are calibrated within a specific temperature range; operating
outside of this range may cause erroneous results; check manufacturers
instructions
d. Ensure that results are read from the SG scale, which differs by species, and
from the total protein and refractive index scales
e. To approximate the SG if the reading is off the scale; dilute the urine 1:1
with distilled water and adjust results accordingly by multiplying the last
two digits of the reading by 2
 (1) For example, a urine sample diluted 1:1 with distilled water with a
reading of 1.030 will have a SG of 1.060 (2 30) when adjusted
for the 1:1 dilution. Do not attempt to make the dilution on the
refractometer, because of the difficulty of obtaining an even mixture
of urine and distilled water
f. The relative specific refractivity of the urine of cats, rabbits, and guinea pigs
differs from that of dogs, large animals, and humans
(1) Therefore the commonly used human-based urine SG scale will
give falsely elevated SG results for cats and falsely low SG results for
guinea pigs and rabbits
(2) Preferably, use refractometers with scales calibrated for the specific
species
g. Glucose, protein (albumin), radiopaque dyes, urea, sodium chloride, and
some antibiotics will raise the SG value (e.g., ~ 0.004 for each gram of
glucose per deciliter of urine, and ~ 0.003 for each gram of protein per
deciliter of urine)
(1) To correct the SG, subtract the relevant increase for each gram of
analyte (e.g., protein or glucose) per deciliter of urine
h. Quality control: check the zero setting/calibration of the refractometer daily
with distilled water (1.000 SG [ 0.05%]) and with a known control (5%
NaCl solution = 1.022 SG [ 0.001])
(1) Adjust refractometer according to manufacturers instructions
2. Urinometer
a. A hydrometer calibrated for urine
b. When the urinometer is placed in a cylinder filled with urine, it will
displace a volume equal to its weight
(1) Therefore the more solute present in the urine, the less volume will
be displaced and the higher the urinometer will float, denoting a
higher SG
c. Requires a large volume of urine (~ 5 to 15 + mL), whereas the
refractometer requires only a drop or two
d. Read results at bottom of the meniscus on the urinometer float
e. Urinometer is calibrated to read samples at room temperature; correct the
SG reading for the urine if the temperature of the urine is not at the
calibrated temperature of the urinometer. Check manufacturers
instructions
f. Quality control
(1) Check the accuracy of the urinometer with distilled water (SG
1.000) at the calibrated temperature
3. SG reagent test strips
a. An indirect colorimetric method in which an increased color change is
correlated with increased concentration of ionic solutes
b. Developed for use with human urine samples
c. Least reliable method of determining SG in animals, especially if SG is
greater than 1.030, the upper limit of the test strips
(1) High concentrations of protein or ketones may give falsely elevated
values, whereas alkaline or dilute urine (low SG) may give false low
values and high urine lipid content may either raise or lower values
d. Not influenced by the presence of glucose or urea
 (1) Read results by comparing color changes with color scale on
container
e. See specific manufacturers instructions
4. Osmometry
a. Unit: milliosmol/kg [L] = mOsm/kg [L]
b. Likely the most representative method of analyzing urine solute osmolar
concentration
c. Measures number of dissolved particles in the urine
(1) Costly instrumentation (osmometers) and time-consuming
method, therefore more likely used in research and reference
laboratories
d. Urine osmolality can be roughly guesstimated from the USG by
multiplying the last two digits of the urine SG (USG) by 36 (e.g., USG: 1.030
1080 [30 36] mOsm/kg [L])
E. Urine SG values
1. Commonly reported SG values (Table 2-2)

TABLE 2-2
Commonly Reported Specific Gravity Values

Approximate possible Common (daily variable- Questionable (marginal) to adequate

Species
maximum range functional) range values*

Canine ~ 1.001-1.075 ~ 1.015-1.045 ~ 1.030 > 1.040 +

Feline ~ 1.001-1.085 ~ 1.035-1.060 ~ 1.035 > 1.045 +

Large ~ 1.001-1.040 ~ 1.015-1.030 ~ > 1.025 +

animal
s
*
Consistent successive results at the low end of or below these values from samples collected at various times throughout the day
may indicate a disorder and would most likely be considered an inappropriate value.
2. Increased SG occurs with dehydration, decreased water intake, acute renal disease,
and shock
a. In these situations, it would be expected that SG would be consistently
higher than ~ 1.035 in the feline, 1.030 in the canine, and 1.025 in large
animals
b. Decreased SG occurs with increased fluid intake and in renal and other
diseases

Chemical Components
I. Urine pH
A. Used to generally assess the bodys acid-base balance
1. pH number expresses the hydrogen ion (H ) concentration or the acidity
+

a. pH < 7 is decreased pH, or acid urine

b. pH > 7 is increased pH, or basic or alkaline urine
B. Reagent strips are most commonly used to determine pH; after being dipped into urine
sample, the color change is compared with the color on a scale on the container
1. Common findings are between pH 5.5 and 8.5 across species
C. pH is often affected by diet
1. Herbivores commonly have an alkaline pH (~ 7 to 8.5); nursing herbivores
commonly have more acid urine
2. Carnivores have an acidic pH (e.g., feline ~ 6 to 7)
3. Urine of omnivores may be either acidic or basic
4. Urine tends to become less acid after meals, because of the alkaline tide
(postprandial gastric secretion of hydrochloric acid)
D. Loss of carbon dioxide occurs when samples are left open and standing at room
temperature, resulting in higher pH readings
E. Standing urine, containing urease-producing bacteria, also increases the reading
F. In highly acidic urine, a false reduction of the pH reading may result because of dripping
from the protein pad onto the pH pad. Therefore technique and timing are critical. See
package insert
II. Protein:
A. Proteinuria usually describes an abnormal level of proteins or protein metabolites in the
urine
 1. Important indicator of renal diseases such as glomerulonephritis, amyloidosis, and
nephrosis
2. When coupled with presence of renal casts may indicate renal disease
B. Small amounts of protein pass through the glomerulus, but most are resorbed by the renal
tubules
C. Detection of protein levels is commonly made with a reagent test strip that generates a color
comparison. Results are recorded as milligrams per deciliter of protein detected
1. Lower limits of detection: ~ 30 to 50 mg/dL; which is specific for relatively
increased amounts of albumin
D. The results for the healthy patient are none or trace (10 mg/dL), and the veterinarian will
interpret the protein results in concert with the urine
E. Results are considered semi-quantitative because of variables in chemical reaction and color
chart comparison
F. Errors can occur
1. False-positive or falsely elevated values may result when the urine is alkaline and
highly concentrated, if the test strip is left in contact with the urine for an extended
period, or if not read at the appropriate time; check the package insert
a. False-negative results can occur if proteinuria is caused by globulins, or
Bence-Jones protein (indicative of multiple myeloma) rather than albumin,
or if protein is present in dilute or acidic urine
2. Depending on the reader and individuality in color determination, different values
may be obtained
3. Proteinuria in diluted urine indicates greater protein loss than in concentrated urine
4. Small amounts of albumin may go undetected with routine chemistry dipstick tests
G. Proteinuria results from several pre-renal and post-renal causes
H. Values must be taken in context with hematology and chemistry results, other urinalysis
results, or other methods of evaluating protein levels
1. Urine proteintocreatinine (UPC) ratio (lower limits of detection: ~ 5
mg/dL) reflects the amount of protein excreted over 24 hours based on a single urine
sample
2. Sulfosalicylic acid turbidometric test (lower limits of detection: ~ 5 to 10
mg/dL)
a. Detects globulins and Bence-Jones protein in addition to albumins
b. Used as a confirmatory test for chemistry test strip positive results,
especially samples with an alkaline pH
3. Micro albumin test (lower limits of detection: ~ 1 mg/dL); detects small
quantities of albumin in the urine
a. Micro albumin level has been associated with a variety of non-renal and
renal diseases, including being an indicator of early glomerular renal disease
b. The full extent of the usefulness of this test is still under study
c. Currently, the available efficacious tests in veterinary medicine are species-
specific immunological (enzyme linked immunosorbent assay [ELISA]) tests
(1) Human MA test strips do not completely match the results of the
species-specific veterinary tests
III. Glucose
A. Detectable levels of sugar are referred to as glycosuria and depend on glucose levels in the
blood
1. Glucose is not commonly detected in healthy animals; it passes through the
glomerulus and is resorbed in the proximal renal tubules
 a. Unless the renal threshold is reached (e.g., ~ 170 to 180 mg/dL [> 6.8
mmol/L] in dogs), glycosuria does not usually occur
b. Therefore, unless there is excess of glucose reaching the tubules that cannot
be resorbed or there is a functional deficit of the tubules, glucose will not be
detectable
B. Testing is usually performed with reagent test strips to detect glucose, and/or reagent tablets
to detect sugars (glucose and other reducing sugars) in the urine
1. If the proteinaceous labile enzymes found in the glucose test pads become inactive, a
false-negative result occurs
C. Check with the manufacturer for details on prolonging the life of unopened, in-date
packages by freezing
D. Hyperglycemia along with glucosuria can be attributed to diabetes mellitus created by
insulin deficiency or function
1. For confirmation of diabetes mellitus, blood glucose level should be evaluated
E. Other factors, such as fear, stress, excitement, intravenous infusion of glucose, and other
diseases also cause glycosuria
1. Fasting is recommended before glucose testing to avoid higher levels after a high-
carbohydrate meal
a. False-positive results can occur after the use of various drugs, such as
salicylates, ascorbic acid, and penicillin
IV. Ketones
A. Any compound containing a carbonyl group and carbon monoxide and having a carbonyl
group containing a chain of carbon atoms
1. Ketone bodies include acetone, acetoacetic acid, and -hydroxybutyric acid
a. Acetone and -hydroxybutyric acid are derived from acetoacetic acid and
result from the catabolism of fatty acid
b. Usually, ketones are filtered by the glomerulus and reabsorbed by the
tubules
c. Ketones are produced during fat metabolism and are important sources of
energy
d. Excessive ketones are toxic, producing central nervous system depression
and acidosis
B. In normal animals, very small amounts are found in the blood
1. If there is increased fat metabolism, excess ketones spill into the urine, causing
ketonuria
2. Ketonuria may occur as a result of incomplete reabsorption by the proximal renal
tubules
3. Ketonemia (excess ketones in circulation [ketosis, acetonemia]) results in ketonuria
C. Commonly, in large animals, ketosis (pregnancy toxemia) is associated with hypoglycemia
consequential to high glucose demands, resulting in increased fat metabolism
1. Typically occurs in early lactation or late pregnancy, whereas in small animals,
ketosis occurs with diabetes mellitus; lack of insulin prevents carbohydrate utilization
D. Several reagent test strips or separate reagent tablets can be used to measure ketone levels
1. Color intensity is proportional to ketone concentration
2. These tests are most sensitive to acetoacetic acid and acetone
V. Bile pigments
A. Commonly detected bile pigments include bilirubin and urobilinogen
1. Only conjugated bilirubin is found in the urine
 2. A small amount of urobilinogen, from the breakdown of bilirubin (as a result of
hemoglobin breakdown) by bacteria in the intestines, is excreted into the urine
3. Excessive quantities of bilirubin is known as urobilinuria or bilirubinuria
B. Determination of bile pigments is made with reagent test strips and tablet tests, with the
tablet tests being more accurate
1. A rough determination of the presence of bilirubinuria can be determined if urine is
shaken and a yellow foam forms
2. Positive bilirubin test pads in cats are usually reliable, whereas in dogs there can be a
significant number of false-negative and false-positive results
a. Urobilinogen is not easily detected; therefore urobilinogen test pads in both
dogs and cats have not been always reliable
C. Bilirubinuria can be seen in several diseases, including biliary obstruction, hepatic infections,
toxicity, and hemolytic anemia
1. Light will oxidize bilirubin if urine is left standing, resulting in a false-negative result
2. Because the liver and kidneys of dogs and cattle have an enzyme that can conjugate
bilirubin, slight bilirubinuria may be normally present in these species
VI. Blood
A. Presence of intact RBCs in the urine is referred to as hematuria, whereas the presence of free
hemoglobin is hemoglobinuria and presence of myoglobin is myoglobinuria
1. Hematuria, hemoglobinuria, and myoglobinuria change the color of urine from pink
to red to brown
a. A crude method to distinguish between myoglobinuria and hemoglobinuria
is to evaluate the plasma/serum for the presence of hemolysis
(1) If the urine and plasma/serum are fresh and both are reddish,
hematuria is most likely present
(2) Colorless plasma is indicative of myoglobinuria, because
myoglobin does not emit a color in the plasma
(3) Myoglobinuria is accompanied by intact red blood cells; an
elevated plasma/serum creatine kinase (CK) may also suggest the
possibility of myoglobin in the urine, because an increase in both
may indicate insult to muscle tissue
(4) In severe cases, urine may be almost black
b. To distinguish hematuria from hemoglobinuria and myoglobinuria
(1) Pre-centrifugation: with hematuria, urine is cloudy because of the
presence of intact erythrocytes
(2) Post-centrifugation of the urine
c. The supernatant will remain colorless in the case of hematuria
d. If hemoglobinuria and myoglobinuria are present, the urine supernatant
will still be reddish
B. Occult blood may also be present, with no visible changes to the urine
C. Hematuria is associated with disease of the urogenital tract
1. Hemoglobinuria indicates some intravascular hemolysis
a. Caution: post collection hemolysis occurs with improperly handled or stored
urine
2. Myoglobinuria generally indicates a pathological condition of muscle or overexertion
D. Besides color interpretation, blood or blood components in the urine are detected with
reagent strips as well as tablets
 1. Because these do not differentiate the cause of blood in urine, microscopic evaluation
to determine RBC number, animal history and examination, and other tests should be
included in the evaluation process
VII. Nitrite level in urine in humans is used as an indirect indication of bacteruria
A. It is believed that ascorbic acid normally presents in canine and feline urine and usually
gives false-negative results
B. Bacterial cultures and microscopic evaluation of fresh urine samples are the best methods for
detecting the presence of bacteriuria
VIII. Leukocyte tests are designed to detect the presence of leukocyte esterase, found in all types of
white blood cells, except lymphocytes
A. False-positive results for cats and false-negative results for dogs are common; therefore it is
best to evaluate fresh urine samples microscopically for the presence of leukocytes
B. In addition, false-negative results may occur in patients with glycosuria and elevated USG,
and in those treated with certain antibiotics (e.g., tetracycline)
C. Falsely elevated results have been observed in old samples and those contaminated with
feces
D. Check package insert
IX. Urobilinogen is formed in the gastrointestinal (GI) tract by anaerobic bacteria breaking down
conjugated bilirubin, with small amounts eliminated in the urine and the majority in the feces
A. When elevated, the test may be indicative of liver or GI tract dysfunction or intravascular
hemolysis
1. Because of the instability of urobilinogen, false-negative results have been observed
in acidic urine, old samples, and those exposed to light and air
2. False-positive results have been observed when the reagent strips have been stored
close to a heat source
3. Unlike in humans, a significantly increased urobilinogen level with the chemistry
dipstick has not been observed in most patients; therefore the usefulness of the test in
animals is questionable

Microscopic Evaluation
Examination of the urine sediment is highly valuable when used with the urine physical and chemistry tests,
and hematology and serum/plasma chemistries. Microscopic evaluation may be considered a form of exfoliate
cytology.
I. Sample preparation
A. Best sample is obtained after a period of extended rest, because it is more likely to be highly
concentrated
B. Refrigerate the sample if it cannot be examined within 20 to 30 minutes. Room temperature
storage can result in bacterial growth, natural chemical breakdown, and cell lysis
C. Thoroughly mix the specimen, transfer to a conical-tip centrifuge tube, and centrifuge
sample at the speed and time specified by the centrifuge manufacturer
1. At least 5 mL fresh urine is ideal, but micro methods and containers are
available for smaller samples
D. Note the volume of sediment; leave a small amount of the supernatant and resuspend the
sediment by gently tapping the bottom of the tube with your finger
1. Using a pipette, transfer a small drop of urine to a clean microscope slide and
examine (NOTE: Do not use a wooden stick, because cells and other constituents
commonly adhere to the stick)
a. Cover-slipping is optional, based on experience and personal preference
 b. Viewing of stained (e.g., wet: Sternheimer-Malbin, 0.5% new methylene blue
[NMB]) or unstained urine is based on experience and personal preference
(1) If staining is done, do not attempt to mix the stain on the slide with
the urine. Mix in the tube for the best suspension of stain and urine
(2) The type of stain will specifically influence the appearance of the
microscopic elements. Use an unstained sample to distinguish
between stain artifacts and urine constituents (Figure 2-1)

FIGURE 2-1 A, Cattle urine (epithelial cells and artifacts). B, Cattle urine (artifactual plant material). C, Cattle urine
(unidentified pollen).
(3) Diff-Quik also can be used for stained urine preparation, with films
prepared in methods similar to blood and other cytology films.
Because urine is a fluid with typically low protein content, it may be
washed off the slide in the staining process. Use of serum-coated
slides may limit the loss of supernatant
E. Reduce illumination (lower condenser), view entire area under the coverslip through a
10 (low power field [LPF]) objective and then through a 40 (high power field
[HPF]) objective
F. Crystals and cast numbers are typically estimated as the average number per LPF
1. Epithelial cells and blood cells are estimated as the average number per HPF
2. Bacteria and sperm are noted as few, moderate, or many under HPF
G. Contaminated or unrefrigerated stale samples should be avoided
1. Samples that have not been thoroughly re-suspended after centrifugation may yield
a non-representative sediment
2. Sediments that were allowed to dry on the microscope slide may make cells
unrecognizable
3. Stain precipitate may mimic cells and crystals
 a. Use fresh stain
b. Strain stain to remove precipitate matter
II. Components of sediment (Figure 2-2)
A. Normally, very few WBCs (leukocytes) are found (Figures 2-3 and 2-4)
1. Most cells in urine are neutrophils, which appear spherical, granular, and larger than
RBCs, but smaller than epithelial cells
2. Excessive number of WBCs is referred to as pyuria or leukocyturia
3. An increased number indicates active inflammatory disease along the urinary tract,
but also can be contaminants from the genital tract
4. More than a few (5 to 8 per HPF) should be regarded as abnormal and investigated
further
5. Note any evidence of bacteria

FIGURE 2-2 Common components of urine sediment. A, Caudate cells (C), crenated red blood cell (CR), degenerated white
blood cell (DW), red blood cell (R), renal tubular (RT), squamous (S), transitional (T), white blood cell (W). B, Casts. Coarse
granular (C), fatty (F), fine granular (FG), hyaline (H), red blood cell (R), waxy (W), white blood cell (WBC). C, Amorphous
urates (A), calcium oxalate monohydrate (C), uric acid (U). D, Amorphous phosphate (AP), bilirubin (B), cystine (C),
struvite/triple phosphate (S), tyrosine (T). E, Ammonium biurate/thorn apple (A), calcium carbonate (CC), calcium
oxalate dihydrate envelope (CO). F, Air bubbles (A), bacteria (B), fungi (F), fat droplets (FD), hair (H), mucus (M),
sperm (S), yeast (Y). (Drawings by Toni Damato-Scheck, AAS, LVT; from Walsh D, Damato-Scheck T, editors: Clinical technician lab manual, State University
of New York at Delhi, Delhi, NY, 2001.)

FIGURE 2-3 Canine red blood cells and one white blood cell (right, center). Clinical pathology for veterinary technicians, class
notes, (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)

FIGURE 2-4 Canine white blood cells, one epithelial cell (left, center), and bacteria. (From Schendel P, editor: Clinical pathology for veterinary

technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)

 B. The number of RBCs (erythrocytes) is also normally small (Figures 2-3 and 2-5)
1. Excessive number of RBCs is referred to as hematuria
2. Hematuria is associated with trauma, calculi, infection, and benign or malignant
neoplasia
3. RBCs appear as pale yellow refractive discs, usually uniform in shape and smaller
than WBCs
a. Sample manipulation can create distortion, crenation, hemolysis, and
confusion with fat or yeast
(1) Fat droplets (Figure 2-6) will float in and out of planes of focus;
RBCs do not. Additionally, fat drops usually vary more in size, do
not take on a crenated appearance, and will stain shades of
iridescent orange with Sudan III or IV stain

FIGURE 2-5 Feline red blood cells and two struvite crystals. (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue

University, West Lafayette, Ind, 2014.)

FIGURE 2-6 Granular cast (center) and fat globules in canine urine. (From Schendel P, editor: Clinical pathology for veterinary technicians, class

notes, Purdue University, West Lafayette, Ind, 2014.)

(2) If a small amount of 2% acetic acid is added to the slide and the
structures disappear, they were RBCs
4. In concentrated urine, RBCs may lose fluid and become crenated (shrunken and
spiked)
a. In dilute urine they may swell or lyse, becoming ghost cells
5. More than a few (5 per HPF) should be noted as abnormal and investigated further
6. RBCs may be a contaminant of the female genital tract in voided samples or poorly
collected catheterized samples
C. Epithelial cells (see Figure 2-4)
1. Three types usually found in urine sediment: squamous, transitional, and renal
2. Squamous cells are derived from the urethra, vagina, and vulva, and are the largest
cells found in urine sediment
a. These are partially or fully cornified, appearing as flat, irregularly shaped
cells with angular borders, and if present, have small round nuclei
b. Usually not seen in samples obtained by cystocentesis or catheterization
c. Their presence is not considered significant
3. Transitional cells come from the bladder, ureters, renal pelvis, and part of the urethra
a. Wide variation in size; may be round, pear shaped, or caudate, typically
with granular cytoplasm
b. Increased numbers are associated with inflammation, such as cystitis
4. Renal cells originate from the renal tubules, are found in small numbers, are slightly
larger than WBCs, and are sometimes difficult to differentiate from WBCs
a. Usually round with a large nucleus
b. Increased numbers indicate renal tubular disease
D. Casts (cylindruria) (see Figure 2-2)
1. Formed in and take the cylindrical shape of the distal and collecting tubules of the
kidneys
 a. Common to all cast formation is an acid environment, presence of
mucoproteins or plasma proteins, increased time of flow through the
tubules, and increased salt concentration
2. Dissolve in alkaline urine; so analyze fresh samples immediately
3. Any structures that are in the tubules at the time the casts are formed may embed
themselves in the cast
4. Casts are commonly indicative of renal tubular or epithelial irritation, inflammation,
and degeneration. Larger numbers of casts may help localize pathological conditions
to the renal tubules, but numbers and types of casts do not always indicate the
prognosis or severity of the disease
a. May be only a few casts in severe chronic nephritis
b. Types of casts may be more indicative of the time the cast has been present
in the tubule and the aging process of the cast
(1) For example, casts degrade in the following order: degenerating
tubule > hyaline cast > renal tubular cells adhere to hyaline
cast > renal tubular cell cast > coarse granular cast > fine
granular > waxy
(2) Usually no casts are found, but it is not unusual to find one or two
hyaline casts or granular casts per LPF in moderately concentrated
urine in the apparently healthy patient
c. The presence of renal tubular cell casts and increased number of granular
casts are commonly indicative of tubular degeneration, whereas WBC casts
suggest inflammation of the tubules, and RBC casts indicate bleeding into
the tubules
d. Cell casts are usually always significant
(1) The conditions may be acute, minor and reversible, or chronic and
permanent
5. Hyaline casts
a. A few may be seen in normal urine
b. Clear, colorless, refractive, and composed of mucoprotein or plasma protein
c. Do not possess formed cellular elements
d. Cylindrical with relatively symmetrical sides and rounded ends
e. Indicates mildest form of renal irritation
f. Seen with low light and may be mimicked by mucus strands
6. Cellular casts (tubular epithelial, RBC, WBC)
a. Epithelial casts contain cells from renal epithelium
(1) Seen in acute nephritis and renal tubule degeneration
b. RBC casts occur when RBCs adhere to the hyaline cast during hemorrhage
into the tubules
(1) RBC casts are fragile, but in fresh urine they appear similar to the
free RBCs, being yellow to orange-red in unstained urine
c. WBC casts occur in an inflammatory process
(1) Composed primarily of neutrophils
(2) Easily visually confused with renal tubular cell casts, especially if
the tubular cells are degenerated
(3) Look for free WBCs; they may be more commonly found in the
presence of WBC casts
(4) Form granular casts as the WBCs degenerate
7. Granular casts (Figures 2-6 and 2-7)
 a. Most common type seen in animals
b. Commonly, contain pieces (granules) of degenerate epithelial cells and
WBCs or precipitated plasma proteins or by-products of protein metabolism
c. The cellular granules may deteriorate from larger pieces of cellular
material, coarse granular casts, to small cellular fragments, fine granular
casts
d. Seen in greater numbers with acute nephritis; may indicate severe kidney
disease

FIGURE 2-7 Granular cast (left, center), sperm, and cystine crystals in canine urine. (From Schendel P, editor: Clinical pathology for veterinary

technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)

8. Fatty (lipid) casts
a. Fatty casts contain small to variable-size, refractive fat droplets
(1) The lipids come from degenerated tubular or epithelial cells, where
the lipid had accumulated
(2) Not unusual in cats with renal disease and dogs with diabetes
mellitus, as well as other tubular diseases
9. Waxy casts are wide, square-ended, and colorless to dull gray, with comparatively
refractive edges, and commonly have a brittle appearance
a. More opaque than hyaline casts and indicate chronic to severe tubular
degeneration, with conditions of extremely low passage rates
b. Can be seen with more light than hyaline casts
E. Crystals (see Figure 2-2)
1. May be normal or abnormal
a. Term crystalline may or may not be of clinical significance
2. Crystal formation is influenced by pH, temperature, concentration, diet, and
medication
a. Results from precipitation of salts in urine, as predicated by concentration of
salt in urine and appropriate pH
3. Struvite (magnesium ammonium phosphate, triple phosphate) (Figures 2-5 and 2-8)
 a. Appear as classic coffin lidsthree- to six-sided colorless prisms
normally found in alkaline urine
b. May be associated with urease-producing bacteria of lower urinary tract
disease, often in association with uroliths
c. Can be found in slightly acidic urine
d. May be found in ruminants that are fed high-grain diets with low C:P ratio
e. Also called triple phosphate uroliths

FIGURE 2-8 Struvite crystal, sperm, and a bilirubin crystal in canine urine. (From Schendel P, editor: Clinical pathology for veterinary technicians,

class notes, Purdue University, West Lafayette, Ind, 2014.)

4. Amorphous phosphate/urates (Figure 2-9)
a. Phosphates found in alkaline urine appear as granular precipitate
b. Urates are similar but are found in acidic urine
c. Ammonium biurate crystals are round and brownish, with long spicules,
sometimes having a thorn-apple or mange mite appearance
(1) Seen in liver disease or portocaval shunts
(2) Commonly found in Dalmatians
FIGURE 2-9 Two calcium oxalate dihydrate crystals (right), amorphous crystals, and calcium carbonate crystals in equine
urine. (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)
5. Calcium carbonate (see Figure 2-9)
a. Often found in normal horses
b. Resemble dumbbells, oval, wheel-like in shape
6. Calcium oxalate (see Figure 2-9)
a. Small, colorless envelopes, sometimes dumbbell or ring formed, usually
with a characteristic X form in the center
b. Generally in acidic urine, but can be seen in neutral or alkaline urine
c. Dihydrate calcium oxalate crystals are found in normal urine
(1) Monohydrate calcium oxalate crystals seen in animals with
ethylene glycol toxicity, or in large animals that ingested oxalates
(2) Also associated with calcium oxalate urolithiasis
7. Leucine/cystine/tyrosine (see Figure 2-7)
a. May indicate hepatic disease
b. Leucine crystals are small and round, with sectioned centers
c. Tyrosine crystals appear spiculated and spindle shaped
d. Cystine crystals are flat and hexagon shaped (six sided)
(1) Their presence may indicate metabolic defect of cystine
metabolism
(2) Possible association with uroliths
e. All three are found in acidic urine
8. Uric acid
a. End product of purine metabolism and oxidation in species other than dogs.
b. The Dalmatian may display increased uric acid/urolith formation caused by
the SLC2A9 gene
9. Bilirubin crystals (see Figure 2-8)
a. Often found if there is bilirubinuria
b. Some drugs, such as sulfonamides, may precipitate and form crystals
 c. Crystals may form in standing urine, especially if the urine is refrigerated or
if the sample is left open to the air and moisture is lost
d. Warming of the urine may cause crystals to dissolve
F. Other cells may be found in urine sediment
1. Spermatozoa (see Figures 2-7 and 2-8) can be seen in the urine of an intact male, but
they are clinically insignificant
2. Parasite ova in the urine sediment may indicate fecal contamination or urine
parasites
a. Dioctophyme renale: giant kidney worm
(1) Affects dogs, wild animals, and other domestic animals
b. Pearsonema plica: bladder worm of dogs, fox, and cats (formerly called
Capillaria plica)
3. Fat droplets are highly refractive, spherical, and of various shapes and sizes; thus
they are often difficult to differentiate from other cells, especially RBCs; however, they
can be stained with Sudan stain, and are in focus just on the underside of the coverslip
a. Bacteria (see Figure 2-4) may not be detected in the sediment until their
numbers approach more than 10,000/mL
(1) When stains are used, be careful to avoid precipitated or bacteria
contaminated stains, because both may be falsely identified as
sediment bacteria
(2) Cultures, Gram staining, and antimicrobial sensitivity testing
should be used for identification of bacteria and selection of the
antimicrobial agent
(3) Bench-top cultures (non-incubated)
(a) Incubated cultures

Uroliths
I. According to the Minnesota Urolith Center the most common type of feline uroliths (urinary stones,
concretions) is calcium oxalate, followed by struvite, whereas historically in the dog, struvite is more
common than calcium oxalate
II. The canine numbers seem to be gradually reversing with more recent submissions
A. Although there are in-house chemical methods for the determination of the composition of
the stones, quantitative mineral analysis at reference laboratories tends to provide the most
accurate determinations
B. Reference laboratories use such techniques as polarizing light microscopy, infrared
spectroscopy, and energy dispersive x-ray spectroscopy

HEMATOLOGY
The most commonly performed hematology procedure is the complete blood count. It commonly includes
determination of total erythrocyte counts, relative and absolute leukocyte counts, packed cell volume (PCV),
total plasma protein, Hb level, RBC indices, and blood film evaluation. See Box 2-1 for precursor blood cells.

BOX 2-1

Precursor Blood Cells in Order of Least Immature to Most

Mature Cells
Erythrocyte Granulocyte Agranulocyte Thrombocyte

Rubriblast Myeloblast Monoblast Lymphoblast Megakaryoblast

Prorubricyte Progranulocyte Promonocyte Prolymphocyte Promegakaryocyte

Rubricyte Myelocyte Monocyte B and T lymphocytes Megakaryocyte

Metarubricyte Metamyelocyte Platelet

Polychromatic erythrocyte Band

Mature
 I. Blood profiles (hemograms or Complete Blood Count) can be expanded to include such parameters as
red blood cells, white blood cells, platelet and reticulocyte values, and red cell mean diameters.
A. The types of cells counted as well as reporting methods may vary slightly according to the
machinations used
B. Tests include PCT, PLT, PDVc, RDVc
1. PLT as an acronym represents platelets found in peripheral blood (circulating blood)
a. PLT is concerned with the platelet count in a blood sample
2. PCT as an acronym represents the test known as a platletcrit or platelet-
crit, one of several platelet indices that may be calculated
a. PCT indicates the relative volume of platelets in a blood sample
II. Actual values may vary based on the methodology, laboratory performing the tests, available
hematology analyzers/equipment and population of patients tested
A. Abnormal patients may fall within the reference value range, and normal patients may be
outside of the range
B. Reference value ranges for the species tend to be wide, whereas individual patient normal
ranges are narrower

Blood Collection and Sampling

I. General rules
A. Collect the smallest amount of blood necessary to perform all tests plus an adequate amount
for retest or errors
1. This will usually be approximately two times the initial amount necessary to
accomplish the tests
2. Use syringes and vacuum collection devices proportional to the size of the patient
and volume needed
 3. Handle blood appropriately to avoid damage (e.g., hemolysis)
B. Ethylenediaminetetraacetic acid (EDTA) is the best anticoagulant for hematology in most
mammals
1. When used in the proper ratio of anticoagulant to blood, it will cause the fewest
changes in cell morphology
a. For birds and reptiles, heparin is a better anticoagulant
2. When using anticoagulants, fill the tube to at least 90% of its capacity to maintain the
proper anticoagulant-to-blood ratio
a. Do not put in more than the volume a vacuum tube will collect
b. Inadequate sample amount will cause crenation of the erythrocytes and
changes in the leukocytes
3. EDTA is not a hematological preservative
C. Be cautious when aspirating with a syringe, or a vacuum collection device that is too large
1. Excessive vacuum may cause cell destruction and injury to the patient
D. When transferring blood from a syringe to a vacuum container, either:
1. Remove the stopper from the tube and the needle from the syringe
a. Gently push on the plunger to evacuate the blood from the syringe allowing
blood to run down the inner wall of the tube
b. Better for preserving cell morphology
2. Carefully pass the needle through the stopper and allow the vacuum to pull the
blood from the syringe
a. Simultaneously pushing the plunger on the syringe along with the vacuum
from the tube will cause excessive pressure and damage cells
E. Mix with gentle inversion, never shake
F. Avoid frequent collection from the same site
1. May cause localized increases in the numbers of leukocytes and platelets, trauma,
pain, and increased chance for hematoma formation
G. Samples collected immediately postprandial may be lipemic
H. Fear, excitement, struggling, stress, treatment, and restraint may cause relative changes in
the patients values, because of redistribution of cells from and to the marginal (storage)
and circulating pools of blood
1. Stress (glucocorticoid-induced) leukogram: mature neutrophilia, monocytosis,
lymphopenia, eosinopenia
2. Develops over several hours and persists for several days
a. Physiological (epinephrine, excitement, fight or flight ) leukogram:
lymphocytosis, mature neutrophilia
3. Develops immediately and can resolve in as little as 30 minutes; more common in
cats
4. Relative polycythemia (transient increase in RBC mass): lacks total plasma protein
increases, resulting from splenic contraction
a. Exercise; epinephrine release from fear, excitement, or pain
b. Manual compression of the spleen while restraining or lifting the patient
c. Dehydration
d. Relative anemia
(1) Usually resulting from a dilution effect from fluid administration
5. Physiological thrombosis resulting from
a. Splenic contraction sequential to epinephrine release, resulting from
excitement and exercise
b. Manual compression of the spleen while restraining and lifting the patient
 I. Medications and fluids may have biological or dilution effects on the sample or may influence
the test procedure
J. Patient history, such as recent vaccinations, surgery, and geographical origin, may influence
results
K. Time of collection to time of testing is critical
1. Sample degradation starts immediately after collection
2. EDTA prevents coagulation but does not preserve the sample

Erythrocyte (Red Blood Cell) Evaluation

See Figure 2-10 and Table 2-3

FIGURE 2-10 Common red blood cell morphological changes and inclusions. A, Stomatocytes (S) and leptocytes: bar cell
(B), folded (F), target cell (T). B, Hypochromic (H), macrocyte (MA), microcyte (MI), normocyte/normochromic (N/N),
spherocyte (S), Torocytes (T). C, Apple stem cell (A), blister cell (B), eccentrocyte (E), Heinz body (H), Howell Jolly body
(HJB), nucleated red blood cell (N), schistocyte (S). D, Acanthocyte (A), burr cell (B), echinocyte (C/E), rouleaux (R). E,
 Dacrocyte/teardrop (D/T), ovalocyte (O), spindle/fusiform cell (S). (Drawings by Toni Damato-Scheck, AAS, LVT; from Walsh D, Damato-
Scheck T, editors: Clinical technician lab manual, State University Of New York at Delhi, Delhi, NY, 2001.)

TABLE 2-3
Erythrocyte Variations (Figures 2-12 to 2-17)

Erythrocyte Variations Description Notes

Variations may be in vivo because of species, breed, environmental influences on the patient, and pathological conditions or in vitro as
a result of problems in analytical methods, and preanalytical and postanalytical patient, collection, sample, and processing variables
There may be multiple variations in or on a given cell or blood film
Colors are as visualized with Romanowsky-Wrightstype stains, unless otherwise noted. Variations may occur with age, brand,
and lot number of stain and staining techniques

ANISOCYTOSIS (Figures 2-12 to 2-15) (A general term denoting variation in erythrocyte size; only microcytic or
macrocytic or combinations of sizes; combinations of sizes are not unusual in normal cattle and cats)

Normocyte Commonly used to describe typical In some texts used to describe the typical shape,
size of erythrocyte for a species size, and color for species. For various species:
Normocytes in mammals with discoid cells
range from ~ 1.5 m D in the Malay
chevrotain (lesser mouse deer) to 7 m D in
the dog to ~ 10.8 m D in the northern
elephant seal. The normocytes of the various
species of reptiles, fish, birds, and amphibians
have similar variations in size. Shape also
varies and influences size. Camelids and
nonmammals have elliptical cells

Macrocyte Larger than typical erythrocytes for Increased MCV, typically polychromatic, with the
the species exception of equine species. Usually immature
cell. Sign of regeneration. When macrocytic
and polychromatic they may be termed
macrocytic polychromatic erythrocytes

Microcyte Smaller than typical erythrocytes Decreased MCV

for the species

Arrangement Cellular Organization Behavior Variations

Rouleaux (pronounced RBCs appear like elongated, Common on the blood films of healthy equine
Erythrocyte Variations Description Notes

ruu low) tumbled stacks of coins species, and to a lesser extent in cats, pigs, and
formation dogs. Increases in any species may be
indicative of an inflammatory or neoplastic
condition. When present, rouleaux formations
are observed throughout the film

Agglutination Indiscriminate three-dimensional Caused by immunoglobulins bound to the

(autoagglutination) clumping of erythrocytes erythrocytes. Although indicative of immune-
mediated hemolytic anemia (IMHA [AIHA]),
the Coombs test is more sensitive in
identifying this condition. These clumps will
be observed throughout the blood film. The
erythrocytes are immunologically
bound and will not disperse with the addition
of normal saline to a drop of the patients
blood. These are not microclots caused by
difficulty in collection of the sample or clotting
pathologies

COLOR VARIATIONS

Normochromasia Typical color erythrocyte for the Suggests an adequate amount of hemoglobin in the
species. Usually pinkish-red cell and typical MCHC for the species. Varying
and influenced by the amount degrees of central pallor and complementary
of central pallor. Mammals biconcavity may be present in species having a
such as camels and llamas, discoid-shaped erythrocyte, with the dog
which have elliptical, more or having the most central pallor, and horse and
less flat erythrocytes, lack goat the least in the common species
central pallor

Hypochromasia Lacking typical color of the Resulting from an inadequate amount of

erythrocyte for the species. hemoglobin. Having a decreased MCHC.
Having an increased central Common with an iron-deficiency anemia
pallor

Hyperchromasia (although Appears as an increase in color Suggests an absolute increase in the amount of
Erythrocyte Variations Description Notes

mentioned in intensity hemoglobin within the cell and increase in

textbooks, the term is MCHC. True hyperchromasia most likely does
not commonly used) not exist, but the presence of hemolysis, Heinz
bodies, and lipemia may produce interferences
in the tests and result in an artifactual
calculated increase in MCHC.
Spherocytes have the appearance (illusion) of
being hyperchromic and smaller as a result
because of the change in shape, from discoid to
spherical (ball-like), resulting in the lack of
concavity and visible central pallor

Polychromasia Varying degrees of bluish-staining This is indicative of varying aged younger cells and
(polychromatophilic, of the erythrocyte cytoplasm. is due to the presence of ribosomes in the cell.
diffuse basophilia, These cells are usually also If stained with a vital stain (e.g., NMB), the
polychromatophil) (see macrocytic reticular structure would be seen and the cell
Figures 2-12 to 2-14) would be noted as a reticulocyte. This sign of
regeneration is indicative of an active bone
marrow. Polychromatic cells are not unusual in
normal dogs and pigs, are fairly common in
young pigs and rats, and are extremely rare in
horses of any age. When macrocytic and
polychromatic, they may be termed
macrocytic polychromatic erythrocytes

INCLUSIONS (Because these are within the cell, they stay in focus with the cell when focusing up and down)

Basophilic stippling (see Variable size and number of blue May be found in lead poisoning; regenerative
Figure 2-15) granules distributed response
throughout the RBC; stay in
focus with the RBC when
focusing up and down

Heinz bodies Usually a singular, ~ 1-4 m in An oxidative injury resulting in denaturing of the
diameter, roundish, hemoglobin. Heinz bodies will not stain with
noselike protrusion Wrights-type stains but will with vital
from the surface of the stains, such as NMB. They are not uncommon
erythrocyte, giving the RBC a in low numbers in healthy cats and may be
Erythrocyte Variations Description Notes

light bulb appearance. associated with hemolytic anemia in all

Most easily observed on the species. Seen in cats ingesting acetaminophen
edge of the RBC and dogs ingesting onions, acetaminophen,
and other oxidative substances and drugs. May
be seen with eccentrocytes

Howell Jolly body (see Usually a singular, relatively round, Remnants of nuclear chromatin. Sign of
Figure 2-14) nonprotruding, dark-purple regeneration. Also found in splenectomized
inclusion approximately patients
~ 1 m in diameter
observed on the surface of the
RBC

Nucleated red blood cell Macrocytic cell with a Immature red cell, usually rubricytes and
(NRBC), metarubricyte polychromatic cytoplasm and metarubricytes. The mature nonmammalian
(see Figure 2-12) nuclear appearance species cytoplasm will be pinkish-red
commensurate with the age of
the RBC. Immature
nonmammalian RBCs will be
rounder and larger than their
mature oval counterpart

Siderotic Bluish, varying sized and shaped Contain iron. Found in such conditions as lead
granules/inclusions granules, usually distributed toxicity and hemolytic anemia
(siderocytes, toward the periphery of the
Pappenheimer bodies, RBC
focal basophilic
stippling)

INFECTIOUS AGENTS (Intracellular and extracellular parasites, bacteria, protozoa, and viral) (these are the more
common agents)

Aegyptianella spp. Very small organisms lacking Intracytoplasmic (within the cytoplasm),
pigmented granules and Pirohemocyton-like (piro- pear-shaped)
varying in appearance with the
species and stage of
Erythrocyte Variations Description Notes

development virus of birds

Anaplasma spp. (see Figure Commonly numerous and small, Worldwide occurrence
2-15) ~ 1 m in diameter, A. centrale: endemic in Middle East, South
A. marginale coccoid (round to oval) shaped, America, southern Africa
usually purple bodies typically
on the margin of the RBC.
Commonly smaller than
Howell Jolly bodies and not as
round

Babesia spp. Common characteristics: colorless to Intracellular (within the cell) piroplasmid
B. bigemina (bovine) light-blue cytoplasm and protozoan of mammals, fish, reptiles (turtles,
B. bovis (bovine) purple-to-red nuclei. More snakes, lizards)
B. caballi (equine) common in the RBCs at the B. felis and B. cati are not believed to be
B. canis (canine) feathered edge of the film currently present in North America
B. equi (equine) B. canis: teardrop to pear-
B. gibsoni (canine) shaped structures, commonly
in pairs
B. gibsoni: round to oval and
elongated

Cytauxzoon felis Oval-ringlike, ~ 1( 0.5) Intracellular protozoan

m in diameter with clear
center; small, blue nucleus;
commonly at one end of the
ring

Distemper viral inclusion If present, found on immature Not commonly found. Usually larger than Howell
body erythrocyte, variable in shape: Jolly bodies. Present in the viremic stage. Can
round to oblong to irregular, be also found in all types of white blood cells
~ 1-2 m in diameter,
blue-gray to pale blue to dark
violetreddish-pink in color;
smooth-glassy to granular in
texture
Erythrocyte Variations Description Notes

Mycoplasma spp. (formerly Small (~ 0.5 m), blue, singular Mycoplasma bacteria. Also present in llamas
Eperythrozoon spp.) or multiple pleomorphic
Candidatus M. ovis (coccoid, rod, or ring shaped)
(formerly E. ovis organisms. May be on or off
[ovine]) the RBC. Ring form common
M. wenyonii (formerly
E. wenyoni [bovine])
M. haemosuis (formerly
E. suis [porcine])

Mycoplasma spp. (formerly Pleomorphic, small. On or off cell Mycoplasma bacteria. Epicellular (immediately
Haemobartonella spp.) beneath the membrane of the cell). Serological
M. haemofelis (Ohio Small, dark-blue rods on the testing is more sensitive than a blood film for
strain, large strain edge of the cell or ring form on diagnosis. Common with FeLV-positive cats.
[formerly H. felis]) the surface of the cell; RBC Candidatus M. haemominutum (small strain,
agglutination is not uncommon California strain): Pathological significance to
Ring forms are uncommon cats is unclear
Small, individual blue cocci to Found more commonly in splenectomized
M. haemocanis (formerly rods, more commonly in chains dogs or those that have splenic pathological
H. canis) that are branching and Y conditions. Most pathological strain
shaped and go across the RBC

Haemoproteus (Hemoproteus) Appearance varies with stage of Intracellular, protozoa of birds

spp. development of the gametocyte
but commonly does not distort
the cell, despite occupying
~ 50% of the cellular area;
may semi-encircle the nucleus;
stains dark purple to pale blue
to pink. Granular purplish-
pink pigmented material
present

Haemogregarina spp., Individual genera are difficult to Affects reptiles, fish, amphibians
hematozoon (snakes) differentiate in the
Hemogregarina (semi- erythrocytes
aquatic freshwater Common characteristics: 1-2
turtles) sausage-shaped
Karyolus (Old World intracytoplasmic gametocytes,
lizard) which cause a distortion of the
host erythrocyte and lack
Erythrocyte Variations Description Notes

refractive pigment granules

Leucocytozoon spp. Fills and distorts cell with a light- to Intracellular, protozoa of birds
dark-staining gametocyte;
commonly elongated and
spindle-shaped cell; commonly
has a two-nuclei appearance:
darker purplish-staining host
erythrocyte nucleus and lighter
purplish-pinkish staining
parasite nucleus; no granular
pigmented material

Microfilaria Dirofilaria Vary with species Microfilarias are extracellular nematodes seen in
immitis (heartworm Earthworm-like with a blunt amphibians, birds, reptiles, fish, and
[dogs, cats, ferrets]) and pointed end. Stain blue mammals. Microfilaria may be
sheathed (e.g., Foleyella furcata found in
reptiles)
D. immitis must be distinguished from the
nondisease-producing Acanthocheilonema
(Dipetalonema) reconditum

Plasmodium spp. Highly variable in appearance Intracellular, flagellate protozoa of birds, reptiles
depending on species of (especially lizards and snakes); avian malaria
Plasmodium and stage of
development, but commonly
erythrocytes are not distorted
and have refractive, granular,
pigmented material

Trypanosoma spp. Slender and wormlike in Extracellular protozoan of amphibians, birds,

appearance, with undulating reptiles, fish, amphibians, and mammals
membrane, narrowed posterior, Usually an incidental finding in birds.
and single flagellum Transmitted by blood-sucking insects

POIKILOCYTOSIS (Figures 2-16 and 2-17) (true [nonartifactual], pathological) (a general term denoting nondescript
Erythrocyte Variations Description Notes

variations in shapes of erythrocytes that are scattered throughout the blood film. NOTE: There is apparently not total
agreement on the definitions and causes for all terms used to describe the shapes of erythrocytes. Poikilocytosis is
common in clinically healthy swine of all ages, young goats, and cattle. Normal shapes may vary from virtually flat
(e.g., goat) to biconcave (e.g., dogs and primates) discs to elliptical (e.g., camelid and nonmammals)

Acanthocytes (spur cell) Varying number of unevenly sized Commonly seen in hepatic associated diseases. May
and spaced fingerlike be seen in apparently healthy young cattle and
blunt projections goats
Metabolic and membrane disorder

Blister cell Blister or vesicle on side of RBC An oxidative injury found with iron deficiency
formed by a thin cell Metabolic and membrane disorder
membrane, forming an area
devoid of hemoglobin; giving
the RBC a padlock-like
Keratocytes (horn cells) appearance Keratocytes and apple-stem cell will most
Ruptured blister with two likely become schistocytes
Apple-stem cell upright cattle hornlike
projections
Ruptured blister forming a
single projection

Crystallized hemoglobin Rod to cubical, usually dark red Not unusual in cats, llamas, and young puppies. No
appearance known pathological significance

Dacryocytes (dacrocyte, Teardrop-shaped erythrocytes with May be found in bone marrow disorders of dogs
teardrop cells) a single elongated or pointed and cats, iron deficiency in ruminants and
end modified ruminants, and kidney and splenic
disorders of dogs. Result of mechanical
fragmentation
Erythrocyte Variations Description Notes

Drepanocyte (sickle cell) Change to a spindle shape This in vitro phenomenon may occur in the blood
(fusiform), being elongated of deer, Angora goat, and some British-breed
and coming to a more or less sheep as a result of an alteration of the
sharp-to-round point on both hemoglobin because of temperature, oxygen,
ends and pH changes

Eccentrocyte (hemi-ghosts) Red at one end of the RBC and Hemoglobin accumulated at one end of the cell.
colorless at the other, giving a Found in hemolytic diseases. Seen in dogs
half-moon appearance ingesting onions, acetaminophen. Oxidative of
to each side hemoglobin. May be found with Heinz bodies

Echinocyte Round-to-elongated cell with Erythrocytes with ruptured cell membranes

relatively evenly sized, shaped, Appearance may vary on the blood film
and spaced blunt or pointed depending on the thickness of the area
projections Metabolic/membrane disorder
Burr cell An in vivo change; may be indicative of renal
(echinoelliptocytes) Appear as elongated ruffled, disease
with relatively evenly sized
and spaced, short, blunt An in vitro artifactual change affecting all the
Crenation (type I projections erythrocytes on the entire film or in a given
echinocyte) Relatively round ruffled area of the film; indicative of excessive
erythrocyte with sharp, evenly anticoagulant, alteration in pH from slow
spaced spicules, which are drying of blood films caused by thick films
commonly seen on the edge of and environmental factors
the RBC An in vivo change, more common in animals
bitten by rattle snakes
Type III
echinocytes Very short, evenly spaced, fine
spicules found on the surface
the mature erythrocyte

Elliptocyte (ovalocyte) Oval or elliptical erythrocyte, being Normal shape for camelid and nonmammalian
more flat than concave species. They have been found in a variety of
bone marrow disorders in dogs and cats,
hepatic conditions in cats, and hereditary
disorders in dogs. Metabolic/membrane
disorder in mammals other than camelid
species
Erythrocyte Variations Description Notes

Ghost cells Extremely pale to colorless, Virtually devoid of hemoglobin in the cytoplasm; in
appearing round to smudge vivo resulting from very recent intravascular
like; may be more visible with hemolysis or in vitro in the blood tube or in
decreased light the preparation of the blood film. If a result of
blood film preparation, they will usually
appear as red smudges

Leptocytes Thin, folded RBC. Commonly larger Increased cell membrane compared with the total
and polychromatic cell volume and internal contents
Found when there is increased production of
erythrocytes, and hepatic conditions
Metabolic and membrane disorder
Target cells Targetlike or Increased surface area of the cell membrane or
(codocytes) bulls-eye decreased cytoplasmic volume; may be found
appearance with red center in such conditions as hepatic disorders, iron
and alternating red and white deficiency anemia, and immune-mediated
rings hemolytic anemia
See Target Cell for causes
Bar cells
(knizocyte) Red barlike out folding
across the center of the cell
appearing similar to the
international no
symbol ()

Schistocytes (schizocytes) Varying size and shaped fragments Usually formed from intravascular shearing of the
of erythrocyte; common cell. Diseases may include disseminated
irregular shapes include intravascular coagulopathy, iron deficiency,
triangles, helmet, crescents; and vascular neoplasms
nondescript Result of mechanical fragmentation

Spherocyte (see Figures 2-12 Dark red staining, appearing Common in hemolytic anemias
to 2-14) smaller than average size,
round, lacks central pallor

Stomatocytes Cup-shaped erythrocytes with an There may be an in vitro artifact in a thick blood
oval, elongated smiley film or in vivo artifact resulting from a
face appearance to the hereditary condition in dogs or drug induced
Erythrocyte Variations Description Notes

central pallor Metabolic and membrane disorder

ARTIFACTS (Because they are on the surface of the cell, they will not stay in focus with the cell when focusing up and
down)

Cellular overlap Crowded cells with uneven Thick area of blood film
distribution of all types of cells

Crenation See Echinocyte

Ghost cells See Ghost Cells

Overstaining General bluish or greenish staining Greenish staining may be due to the exposure of
(pseudopolychromasia) of cells regardless of age sample to formalin; bluish staining may be due
to prolonged exposure to the basophilic
component of the stain

Stain precipitate Varying shape and size, usually Check film, staining and drying technique, and
purple granules on and around condition of stain. Do not shake stain container
the cell do not stay in focus to attempt to resuspend precipitate
with the cell when focusing up
and down

Stomatocyte See Stomatocyte

Refractile artifacts (water Varying shape and size Check blood film staining, rinsing and drying
droplets/residue, bubbles that refract technique. Blood on slide may not have been
Erythrocyte Variations Description Notes

refractory bubbles) when focusing up and down completely dry before staining. May be water
residue or gas trapped as it escapes the cell

Torocytes (punched-out Abrupt change from dense red to Must be distinguished from hypochromic RBCs
cells) white area giving a Artifact of improper spreading of blood on
punched-out slide
appearance, in contrast to a
gradual change with a normal
central pallor; may appear
smaller than normal RBCs
FELV, Feline leukemia virus; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; NMB, new
methylene blue; RBC, red blood cell.
I. Erythrocyte PCV (measured value)
A. Also termed hematocrit (Hct) (calculated value)
B. Determines percentage of RBCs in the circulating blood volume
C. Most easily measured by filling a microcapillary or hematocrit tube with fresh,
anticoagulated blood
D. Tubes are sealed and centrifuged at high speed
1. Actual time depends on the speed and centrifugation angle
2. Hematocrit centrifuges are often preset for speed
3. Goat and sheep blood should be centrifuged for twice the time of dog blood
a. The mean size of small RBCs (< 4 to 5 m) in goat and sheep blood
increases cell numbers and subsequent packing time
E. Results are determined by use of a scale on the centrifuge or hand-held card
F. Results are reported as percentage (%) in conventional units (or as liter per liter [L/L] in SI
units)
G. Color (e.g., hemolysis, icterus) and clarity (e.g., lipemia) of plasma, presence of microfilaria,
and total plasma protein (TPP) can be evaluated from the plasma fraction of the PCV (Hct)
tube
H. The hydration status of the patient will relatively influence the values; dehydration relatively
increases the value and over hydration relatively decreases values
I. A calculated Hct may vary from an actual PCV because of influences of methodology
II. Erythrocyte total numbers
A. Determined by using an automated (e.g., impedance counter, flow cytometry, etc.) or a
manual cell counting device
1. At the time of printing, methods include the manual Thoma erythrocyte diluting
pipette and Unopette replacements available through Bioanlysis GmbH
(manufactured in Germany) and Medix (CA)
B. Automated counters require calibration for cell size, depending on species
C. Manual counts are made with a hemocytometer and are usually not as accurate
D. Both methods require that the sample be diluted before counting
E. Total erythrocyte count usually has no advantage over the PCV except to determine the RBC
indices
F. Total RBC numbers are reported as millions per microliter (n 10 /L), or as millions
6

per liter in SI units (n 10 /L)

12

III. Hemoglobin
A. Part of the RBCs responsible for carrying O and CO
2 2

B. Assists in acid-base regulation by eliminating CO

C. Can be measured by photometric methods or directly or indirectly measured on automated
cell counters
D. Used for determining erythrocyte indices
E. Measured in grams per deciliter (g/dL)
F. For a quick estimation, the normal animal Hb content is about one third of the PCV
1. This ratio is based on a typically healthy patient with an average RBC size of 7 m
IV. Erythrocyte indices
A. Determined by use of the total RBC numbers, Hb content, and PCV; many electronic
instruments automatically include these values
B. Used in classifying types of anemia
C. Mean corpuscular volume (MCV)
1. Mean volume of a group of erythrocytes
2. Terminology with regard to their size
a. Macrocytosis is increased MCV
(1) Also known as macrocythemia
(2) Observed in greyhounds as well as miniature poodles with
hereditary bone marrow dyscrasia
b. Microcytosis is decreased MCV
c. Normocytosis is size appropriate for the species
d. Anisocytosis is varying cell size (not used as a descriptor for MCV)
(1) Normal in cattle
(2) Occurs in regenerative responses with accelerated erythropoiesis
2. MCV is calculated by multiplying PCV (%) by 10 and dividing the product by the
total RBC count (number of millions)
a. As an example, for a PCV of 45% (use as a whole number) and an RBC
count of 5,000,000/L (5 million): (45 10) 5 = 450
5 = 90 fL
3. MCV is recorded in femtoliters (fL); normal ranges vary among species
4. For SI units, divide the PCV (L/L) by the RBC count and multiply by 1000
D. Mean corpuscular hemoglobin (MCH)
1. Mean weight of Hb contained in the average RBC
a. MCH is calculated by multiplying the Hb concentration by 10 and dividing
the product by the total RBC count (number of millions); for example, for an
Hb level of 15 g/dL and RBC count of 5,000,000/L: (15 10)
5 = 150 5 = 30 pg
b. Results are recorded in picograms (pg)
2. Considered the least accurate of the indices, because Hb level and RBC count are less
accurate than PCV
E. Mean corpuscular hemoglobin concentration (MCHC) is the concentration (proportion) of
Hb in the average RBC
1. Terminology regarding hemoglobin concentration
a. Hypochromasia = decreased MCHC/increased level of central pallor
(1) Seen in iron-deficit anemic dogs with congenital portosystemic
shunts
b. Hyperchromasia = increased MCHC (usually artifactual)
c. No true hyperchromic state is thought to exist
d. Normochromasia = MCHC appropriate level of central pallor for the
species; is also known as normochromia
2. MCHC is calculated by multiplying the Hb concentration by 100 and dividing the
product by the PCV (%)
a. For Hb of 15 g/dL, and PCV of 45% (use as a whole number): (15
100) 45 = 1500 45 = 33 g/dL or 33%
b. Results are reported in g/dL (g/L)
c. For SI units, divide the Hb concentration (g/L) by the PCV (L/L)
d. Considered the most accurate of the RBC indices because it does not require
the RBC count
F. Red cell distribution width (RDW) is an electronic measurement of width of the RBCs
1. Higher RDWs indicate increased anisocytosis, whereas normal values indicate
normal cell size variations
 V. Reticulocyte count
A. Expression of the percentage of RBCs that are reticulocytes, or immature erythrocytes still
containing the ribosomes
B. Wrights stain causes a polychromatophilic staining, or diffuse, blue-gray color
1. Red blood cells stained in this way are referred to as polychromatophilic erythrocytes
C. Cats possess two forms: aggregate and punctate
1. Only the aggregate form should be counted
2. Similar to other species, this contains large clumps that appear polychromatophilic
a. Punctate form contains small aggregates of ribosome, easily seen due to
slow maturation
D. A few drops of blood are mixed with an equal amount of NMB stain
1. This mixture is used to prepare a conventional blood film that shows up as deep blue
granular material in the young RBCs
E. Percentage of reticulocytes per 1000 RBCs or an absolute count in reticulocytes per milliliter
is reported
1. Absolute reticulocyte count/L = reticulocyte % total RBC count/L
F. Useful in assessing the bone marrow response to anemia in all domestic animals, except for
horses, because they do not release reticulocytes from the bone marrow
G. Depending on species, presence of reticulocytes in peripheral blood usually indicates
increased erythropoiesis

Leukocyte (White Blood Cell) Evaluation

I. Total leukocyte counts may be made manually or with automated cell counters
A. For a manual count, a Neubauer hemocytometer and a dilution system such as BMP
LeukoChek dilution system may be used for sample preparation (Biomedical Polymers,
Gardner, Mass.)
1. Erythrocytes are lysed through such systems to limit interference with the count
B. Automated counters use a variety of methods
1. Impedance, quantitative buffy coat and flow cytometry are three methodologies
utilized within mechanical hematology analyzers to generate data for the complete
blood count (CBC)
C. Nucleated red blood cells (NRBCs) may interfere with the leukocyte counts, because they
mimic the leukocyte and inflate the count
1. Manual counting methods and automated systems that lack the sophistication to
address correcting for the presence of NRBCs must be manually corrected using the
values gained in the WBC count and an enumeration of the number of NRBCs
observed in the counting and identification of 100 WBCs on the differential film
a. Example: total WBC is 9000/L (n 10 /L) 10% NRBCs or 900
9

absolute NRBCs
(1) 9000 900 = 8100/L as the corrected total WBC
D. Avian and reptilian leukocyte count
1. Birds and reptiles have NRBCs, which makes determining a WBC count difficult
with the mammalian methods
a. With the advent of laser flow technology, the possibility of an automated
counting method of non-mammalian blood cells exists
2. Manual methods are currently regarded as somewhat crude and seldom used within
clinical practice. The manual methods include the use of various reagents to highlight
desirable cells and lyse the undesirable cells for the purpose of viewing
 a. BMP LeukoChek (Biomedical Polymers, Gardiner, Mass.) or LeukoPet
available through Vetlab Supply are examples
E. Increased WBC count is leukocytosis
F. Decreased WBC count is leukopenia
II. Leukocyte evaluation and differentiation
A. WBC evaluation and differentiation is performed by examining the stained blood film
1. Traditional stains include Wrights, Wright-Giemsa, and Diff-Quik (American
Scientific Products, McGraw Park, Ill.)
2. Techniques vary
a. Follow manufacturers directions
B. Cells should be examined and counted in an area of the blood film where distribution and
staining properties are best
1. Monolayer of cells is preferable; examination is completed using 100X oil immersion
magnification
2. Avoid feathered edge counting because of increased number of artifacts, but
scan this area because it is not uncommon for blood parasites and basophils to be
located here
3. If a coverslip is put on immersion oil, there is more definition of cells
C. One method of obtaining a subjective analysis of the estimated WBC count per L, may be
performed by counting average of WBC per high power (40 ) field 2000
D. Leukocyte differentiation according to absence or presence of granules visible in cytoplasm
1. Agranulocytes possess no cytoplasmic granules (lymphocytes, monocytes)
2. Granulocytes possess cytoplasmic granules (basophils, neutrophils and eosinophils)
E. Leukocyte differential numbers should always be reported as absolutes
1. Percentage of each cell type is multiplied by the total WBC count/L
a. Example: 60% neutrophils 10,000 WBC/L total = 6000
(absolute) neutrophils/L
F. Leukocyte morphology (Table 2-4)

TABLE 2-4
Leukocyte Morphology (Figures 2-11 to 2-19)

White Blood Cell

Description Notes
Variations

Neutrophils*

Neutrophils (Figures Irregular, segmented nucleus with coarse Granulocyte; also classed as an acidophil in
2-11 to 2-17) clumped chromatin staining dark purple reptiles; most common peripheral WBC in
Cytoplasm is pale blue with faint companion animals
granulation Species variations: second most common
WBC in cattle; horse neutrophils show
more segmentation than dog neutrophils;
granules in canine neutrophils are
commonly not distinctive; avian and
White Blood Cell
Description Notes
Variations

other nonmammalian neutrophils are

commonly called heterophils and have
rectangular granules versus rounder
granules in mammalian species
Average life span of 10 hr
Phagocytic and bactericidal properties
Neutropenia may be due to decreased
survival of cells, reduced or ineffective
production, or sequestration; will likely
produce a degenerative left shift (more
immature than mature neutrophils)

Neutrophilic bands Sausage to horseshoe shaped; symmetrical Immature neutrophil stage; inflammation is
(see Figure 2- nuclear borders with rounded ends usually indicated by increased bands;
14) increase may also be due to stress,
exercise, glucocorticoid use, or leukemia
Increased numbers of immature
neutrophils = left shift
Degenerative left shift = number of
immature neutrophils exceeds the
number of mature cells; decreasing total
WBC count
Regenerative left shift = number of
mature neutrophils exceeds the number
of immature, but total WBC is at a typical
to increasing number
Orderly left shift = number of each
immature cell stage decreases with the
degree of immaturity of the cell stages

Pelger-Hut Hyposegmented bilobed nucleus that appears Congenital, nonpathological disorder in dogs
anomaly like peanuts in a shell or eye and cats
glasses, with cytoplasm appearing False left shift
mature and chromatin condensed A transient pseudoPelgar-Hut
anomaly may occur with some severe
inflammatory diseases in cattle, horses,
and pigs
Also may be present in eosinophils and
basophils
White Blood Cell
Description Notes
Variations

Neutrophilic Compared to the band: nucleus more kidney One stage younger than bands; rarely found in
metamyelocyte bean shaped, chromatin less condensed, circulating blood
cytoplasm deeper blue

Toxic neutrophils Appearance varies, based on type and species Changes not necessarily reflect toxic effect of
(reactive bacteria; are morphological abnormalities
neutrophils) occurring during shortened maturation
time in the marrow; most reflect
asynchronous maturation between the
nucleus and cytoplasm

Dhle bodies Appear as small, gray-blue cytoplasmic Indicative of mild toxemia. More abundant in
inclusions cats and horses

Basophilia Blue cytoplasm, usually with vacuoles Slightly more severe signs of toxicity and
Nuclear segmentation increased for what is reactivity
typical for the species

Hypersegmentation Increased segmentation beyond what is typical Implies older neutrophils; right shift = an
(see Figure 2- for the species increased number of hypersegmented
18) neutrophils

Barr body (sex bud Appendage on the nucleus shaped like a Found typically on the neutrophils of females
or lobe) drumstick or tennis racket and occasionally hermaphrodites; may
also be found on other granulocytes

Lymphocytes (see Figures 2-11, 2-12, and 2-18)

Lymphocyte Typically round, larger than RBC; vary in size Agranulocyte

White Blood Cell
Description Notes
Variations

from small to large; large nucleus, staining Function in immunological defense

deep purple with dense chromatin, usually Cattle tend to have more lymphocytes
eccentrically placed and occupying most of than neutrophils
the cytoplasmic area; cytoplasm typically
darker at the periphery of the cell and
becomes lighter as it approaches the
nucleus (perinuclear clear zone,
ballerina skirting effect), and may
have small purple-pinkish granules
(azurophilic)

Reactive (activated) Possibly more pronounced: perinuclear zone, A sign of antigenic stimulation
lymphocytes basophilic cytoplasm, azurophilic granules,
or cytoplasmic vacuolization; possible
nuclear variations, including indentation

Kurloff body Large, single, granular inclusion in the Guinea pig

cytoplasm

Plasma cell Eccentric, round nucleus with End stage of B lymphocyte differentiation;
condensed/clumped chromatin; deep blue rarely seen in circulating blood
staining cytoplasm; perinuclear to
juxtanuclear (next to) clear zone (Golgi
apparatus); smaller nucleus in relation to
cytoplasm in contrast to typical lymphocyte

Monocytes (See Figures 2-13 and 2-16)

White Blood Cell
Description Notes
Variations

Variable nuclear shape (kidney bean shape, Largest of the peripheral WBCs; circulate
elongated, lobulated) with diffuse briefly in blood before entering tissues as
chromatin, not as intensely stained; blue- macrophages
gray cytoplasm, possibly with vacuoles and
fine pink granules; may be difficult to
distinguish from band neutrophils or
metamyelocytes

Eosinophils (See Figures 2-17 and 2-19)

Nuclear structure similar to that of neutrophils, Granulocyte; also classed as an acidophil in

but chromatin not as coarsely clumped; reptiles
distinctive red- to pink-staining cytoplasmic Dog: varying size, round red granule,
granules that vary in size and shape among similar in color to RBCs on the film
species Cat: eosinophil granules tend to be rod
shaped, small, and numerous
Horse: intense orange-red, large, round,
granules (strawberry-like in appearance)
Cattle, sheep, and pigs: stain intense pink
and are round
Increase is noted in the presence of
parasites and allergic or hypersensitive
reactions
Increase tends to parallel increases in
basophils and mast cells

Basophils (See Figure 2-19)

Cytoplasmic granules stain blue to blue-black Basophils: a rare finding in peripheral blood
(lavender in cat) and vary in number, with a Involved with hypersensitivity reactions
few commonly indistinct granules in dog,
and more numerous and distinct granules
in horse and cow; gray-blue cytoplasm
often with small vacuoles; when present, it
is not unusual to find basophils more to the
periphery of the film
White Blood Cell
Description Notes
Variations

Leukocyte Infectious Inclusions

Bacteria Clinically significant if neutrophils contain

phagocytized bacteria

Ehrlichia (E.) Morula containing several small, blue to purple E. canis: dog monocytes and lymphocytes
coccoid-shaped bodies E. ewingii: dog neutrophils and
eosinophils (granulocytic ehrlichiosis)
E. phagocytophila: cattle

Neorickettsia Similar appearance to canine Ehrlichia Equine: causes Potomac horse fever, can also
(Ehrlichia) infect dogs and cats
risticii

Anaplasma Similar appearance to canine Ehrlichia Equine neutrophils and eosinophils

phagocytophila
(Ehrlichia equi)

Histoplasma Varying number of ~ 3 m diameter, round to Yeasts

capsulatum oval in shape, light blue cytoplasm; pink to Dogs: neutrophils, eosinophils and
purple, granular, eccentrically located monocytes
nucleus

Hepatozoon canis Elliptical, light blue staining Dogs: neutrophils and monocytes

Canine distemper Varying size and shape with pinkish-reddish to Dogs: any WBC
viral inclusions light purple inclusion, granular to smooth
texture organism, with or without a halo
White Blood Cell
Description Notes
Variations

effect

Lysosomal storage Varying appearances: pinpoint purple granules Example of lysosomal storage diseases
disease in the cytoplasm of WBCs similar to toxic include: gangliosidosis, mannosidosis,
granulation but without other toxic signs; mucopolysaccharidosis, and Niemann-
multiple vacuoles in lymphocytes, possibly Pick disease
with granules in the vacuole

Other Leukocyte Variations

Basket (smudge) Lacy, netlike, or with crisscross basket May be in vivo from an overwhelming
cells weave pattern; nuclear remnant, lacking pathology or in vitro from excess
intact cytoplasm anticoagulation, rough handling of the
sample, or extended period from
collection to processing
*
PMN, Polymorphonuclear synonyms: heterophil in avian, reptile, and fish; and pseudoeosinophil in rabbits, and some rodents. It is
an older term but still may be seen in laboratory animal and European literature. RBC, red blood cell; WBC, white blood cell.

FIGURE 2-11 Canine lymphocyte (left) and neutrophil (right). (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue

University, West Lafayette, Ind, 2014.)

FIGURE 2-12 Canine lymphocyte (upper center), metarubricyte (lower right). Polychromasia, anisocytosis, and spherocytes
(small, dense red blood cells). (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)
FIGURE 2-13 Canine monocytes. Polychromasia, anisocytosis, and spherocytes (small, dense red blood cells). (From Schendel P,

editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)

FIGURE 2-14 Canine neutrophil (lower left) and band (upper right). Howell Jolly body (center), polychromasia, anisocytosis,
spherocytes, and a giant platelet (right of band). (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West
Lafayette, Ind, 2014.)
FIGURE 2-15 Bovine neutrophil (center), basophilic stippling (left of neutrophil), anisocytosis, and anaplasmosis organisms
(small blue dots along edges of red blood cells). (From Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West
Lafayette, Ind, 2014.)

FIGURE 2-16 Canine monocyte (left) and neutrophil (right). Poikilocytosis is present in a few of the red blood cells. (From

Schendel P, editor: Clinical pathology for veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)
FIGURE 2-17 Feline neutrophil (right, center), eosinophil (upper right), and poikilocytosis. (From Schendel P, editor: Clinical pathology for

veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)

FIGURE 2-18 Feline lymphocyte (left), hypersegmented neutrophil (center), and neutrophil (right). (From Schendel P, editor: Clinical

pathology for veterinary technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)
FIGURE 2-19 Canine eosinophil (left), basophil (center), and neutrophil (right). (From Schendel P, editor: Clinical pathology for veterinary

technicians, class notes, Purdue University, West Lafayette, Ind, 2014.)

Thrombocyte (Platelet) Evaluation

I. General information
A. Anuclear cytoplasmic fragments from bone marrow megakaryocytes in mammal; nucleated
in non-mammalian species
B. Vary in size, shape, and color
1. In mammals, usually pale blue cytoplasm, varying in shape, with filamentous
projections when activated. Most species may have more or less obvious granules,
which are usually reddish-purple
a. Platelets from equines have a tendency not to stain as brilliantly as those of
other species
2. Platelets from non-mammalian species usually are more oval than round; commonly
smaller than RBCs; with virtually clear, colorless cytoplasm; and possibly have
cytoplasmic vacuoles and granules
C. May be found in clumps (especially in cat)
D. Thrombocytes (platelets) are an important component of hemostasis
E. Adequate number is a subjective term, which varies with the laboratory and is
meaningful only if the patient does not have occult or obvious bleeding
1. Commonly, estimates of ~ 6 to 10 + platelets per oil immersion field in most
mammalian species and ~ 12 + per 1000 RBCs in birds have been considered
adequate. Average number of platelets in 10 oil immersion fields, in an area where
RBCs are evenly distributed, is multiplied by 20,000 for a rough estimate per
microliter
2. With decreased estimates, platelet aggregation on the blood film or tube of blood
must be ruled out before thrombocytopenia (decreased platelet numbers) is confirmed
a. Look for platelet clumps, commonly located around the feathered edge and
in the thicker areas of the film
 F. Actual counts can be done manually with the hemocytometer or an automated cell counter
(PLT-preferred method of evaluating the number of platelets)
1. Thrombocytopenia
a. Decreased platelet number, resulting from a variety of primary and
secondary causes with possible common clinical manifestations
(1) Examples: trauma and associated hemorrhage, rodenticide
poisonings, immune-mediated, medication side effects, neoplasms,
and infectious agents
(2) Examples include Babesia, Ehrlichia, Haemobartonella, Rickettsia,
Toxoplasma, feline leukemia virus (FeLV), feline infectious peritonitis,
and feline immunodeficiency virus
b. In mammals, commonly a platelet number < 100,000/L is a red flag;
when < 20,000 to 50,000/L, spontaneous bleeding may occur
2. Thrombocytosis: increased platelet number usually exceeding 1,000,000/L
a. Essential (idiopathic, primary hemorrhage)
b. Thrombocythemia: chronic and extremely elevated platelet count caused by
a bone marrow disorder
(1) Reactive (secondary) thrombocytosis: transient sequela to trauma,
splenectomies, specific medications, and various diseases not
originating in the bone marrow
(2) Physiological thrombocytosis
(a) Commonly caused by movement of platelets from the
storage pools (e.g., spleen) as a result of stress and exercise
II. Mean platelet volume (MPV) provides an average size of platelets
A. An increased value suggests the presence of younger or reactive giant (macro-, mega-)
platelets (see Figure 2-11), a regenerative response
B. A decreased value implies the presence of micro-platelets (small), possibly caused by
immune-mediated platelet destruction
C. Healthy patients in some species (e.g., cats) have highly variable platelet size

Total Protein
I. Combination of various proteins produced mostly by the liver
A. Albumins and globulins may be measured using plasma
B. Fibrinogen and other substances consumed by clot formation are not measured when using
serum
II. Abnormalities indicate diseases in tissues responsible for protein synthesis, catabolism, and loss
III. Total plasma or serum protein measured in grams per deciliter (g/dL) (g/L)
IV. Commonly measured with a refractometer or automated chemistry analyzer
V. Influenced by the hydration status of the patient
A. High concentration: dehydration, inflammatory responses, neoplasia, and multiple myomas
B. Low concentration: loss of protein or hemodilution

Instrumentation
I. Quantitative buffy coat analysis, flow cytometry, impedance counter
II. Each of these methodologies has a place in the clinical laboratory. General principles must be
recognized when using any of these instruments
A. The results will be only as good as the sample provided
B. Each instrument has limitations, which may include:
 1. Species specificity resulting from cell size variations (especially RBCs) and presence
of NRBCs and platelets, and cell behavior (e.g., Rouleaux)
a. Some instruments require modifications and validation when the blood of a
different species is counted to accommodate these differences
2. Limitations on the number of cells (high and low) that may be accurately counted
3. Limitations on the ability of the instrument to discriminate between cell types when
the cells are similar in appearance (e.g., size, weight, nuclear components, cytoplasmic
inclusions)
4. Susceptibility to common inferences (e.g., microfilaria, platelet and WBC aggregates,
micro-clots)
5. Select an instrument based on the species to be tested, parameters (e.g., WBC, RBC,
MCH, MCHC, RDW, MPV, platelet, Hct, Hb, differential, mini-differential )
6. When the instrument is working properly, the results will generally be more accurate
and more rapid than those from manual methods
7. All instruments and methods must have a quality control and quality assurance
program that includes actual counts on known control samples for the species
routinely tested, calibration confirmation, and recalibration of instruments when
necessary
a. Despite recommendations from some manufacturers that these procedures
be performed on a weekly or monthly basis, these tasks should be
performed at least daily, whenever the instrument is shut down and
reactivated, and when a problem occurs and is resolved
8. All cell identification must be confirmed on a stained blood film

REVIEW QUESTIONS
1. In qualitative and semi-quantitative urine analysis, which type of substance is exogenous?
a. Uric acid
b. Phenolsulfonphthalein
c. Amino acid
d. Hormone

2. Urine samples should be analyzed within ________ for maximum valid information.
a. 2 minutes
b. 30 minutes
c. 1 hour
d. 12 hours

3. Normal freshly voided urine of many species is clear. Exceptions include which of the following
species?
a. Rabbit
b. Horse
c. Hamster
d. All of the above

4. It is recommended that urine sample size be standardized. An adequate sample of fresh urine is
considered to be:
 a. 1 mL
b. 5 mL
c. 10 mL
d. 20 mL

5. When assessing a patients diet, which urine specimen collection time is likely to be most helpful?
a. 5- and 10-minute intervals postprandial
b. 30- and 60-minute intervals postprandial
c. 1 to 2 hours postprandial
d. 3 to 6 hours postprandial

6. Which is the preferred anticoagulant for conducting hematology in a parrot?

a. Heparin
b. EDTA
c. Potassium chloride
d. Acid-citrate-dextrose (ACD)

7. To maintain proper anticoagulant to blood ratio, sample tubes should be filled to at least what
capacity?
a. 90%
b. 75%
c. 60%
d. 50%

8. Blood samples collected immediately postprandial may be:

a. Icteric
b. High in TPP
c. Lipemic
d. Low in RBCs

9. Which urine collection method is optimal for bacterial culture?

a. Manual expression
b. Cystocentesis
c. Midstream
d. Litter pan pour-off

10. Pollakiuria is defined as:

a. Complete absence of urine formation
b. Increased urine excretion
c. Frequent urination
d. Decreased urine formation

11. A smudge cell is a:

a. Fragmented erythrocyte
b. Small, dark-stained erythrocyte
c. Nucleated cell that has ruptured as a result of damage to cell during smear making
 d. Tissue cell with granules

12. MCHC is calculated by multiplying:

a. Dividend of PCV/RBCs by 1000
b. Hb by 10 and dividing by product of total RBC count
c. Hb concentration by 100 and dividing by PCV
d. PCV by 10 and dividing product by total RBC count

13. MCV is calculated by:

a. Multiplying Hb by 10 and divide by total RBC count
b. Dividing PCV by RBC count and multiply by 1000
c. Multiplying PCV (%) by 10 and dividing by total RBC count
d. Multiplying Hb concentration by 100 and dividing by PCV

14. Mean corpuscular hemoglobin is:

a. Defined as mean weight of the RBC compared to Hb within the cell
b. Defined as mean weight of Hb contained within the average RBC
c. Recorded as femtoliters
d. Recorded as g/dL

15. Which is true of reticulocytes?

a. They are mature erythrocytes that still contain ribosomes
b. Wrights stain causes a polychromatophilic staining, or diffuse, purple-red color
c. In cats, only the aggregate form should be counted in a reticulocyte count
d. a and c

16. Basophilic stippling is the presence of small, blue-staining granules within:

a. Erythrocytes
b. Leukocytes
c. Platelets
d. Basophils

17. Which of the following is likely the most representative method of analyzing urine solute osmolar
concentration?
a. Urine pH
b. Cystocentesis
c. Osmometry
d. Specific gravity

18. NRBCs are normal in which species of animals?

a. Ruminant and equine
b. Avian and reptile
c. Equine and reptile
d. Avian and equine

19. An increased WBC count is indicative of:

a. Anisocytosis
 b. Agglutination
c. Leukocytosis
d. Leukopenia

20. Which of the following describes an elevated platelet count caused by bone marrow dysfunction or
pathology?
a. Thrombocythemia
b. Thrombocytosis
c. Reactive thrombocytosis
d. Physiological thrombocytosis

CHAPTER 20

Pharmaceutical Calculations
METRIC SYSTEM
The metric system can also be referred to as the SI system, or Systme International dUnits.

Metric Conversions
I. Abbreviations of commonly used units are shown in Table 20-1. The prefix and a base unit are also
shown

TABLE 20-1
Prefix, Abbreviation, and Base Unit for Metric Units

Prefix Symbol Value

giga G base unit 10 (largest unit)

9

mega M base unit 10 6

kilo k base unit 10 3

Prefix Symbol Value

hecto h base unit 10

2

deca dk base unit 10

Base unit

gram g, gm

meter m 1

liter L

deci d base unit 10

1

centi c base unit 10

2

milli m base unit 10

3

micro base unit 10

6

nano n base unit 10

9
Prefix Symbol Value

pico p base unit 10 12

(smallest unit)

II. Metric unit conversion methods

A. Step method
1. Move the decimal place to the right if converting to a smaller unit, and to the left if
converting to a larger unit
2. Example: to convert 500 milligram (mg) to gram (g)
a. As shown in Table 20-2, 100 mg is 0.001 of a gram (1000 mg = 1 g)

TABLE 20-2
Common Medical Units and Conversions

Unit Value

liter (L) to milliliter (mL) 1 L = 1000 mL

gram (g) to milligram (mg) 1 g = 1000 mg

milliliter (mL) to microliter (L) 1 mL = 1000 L

meter (m) to centimeter (cm) 1 m = 100 cm

kilometer (km) to meter (m) 1 km = 1000 m

microgram (g) to milligram 1 g = 0.001 mg

Unit Value

b. Therefore the decimal must move 3 decimal places

c. Also, 1 g is larger than 1 mg; therefore the decimal place must move to
the left
d. The answer is 0.5 g
B. Proportion equation
1. Example: to convert 500 mg to g
a. According to the chart, 1 g = 1000 mg
b. Therefore x g/500 mg = 1 g/1000 mg
c. (x = unknown number)

C. Common conversions
1. 1 000 g = 1 mg
2. 1 000 mg = 1 g
3. 1 000 g = 1 kg

Metric Date
I. A metric date is written in the following format: year/month/day/time
A. Example: January 24, 2003, is written 2003/01/24
II. There may be a slash, dot, or space between the numbers
III. In the United States the date is commonly written month/day/year
A. Example: 01/24/2003

Metric Temperature
I. Centigrade or C (capital C)
A. Freezing point = 0 C at 1 atmospheric pressure
B. Boiling point = 100 C at 1 atmospheric pressure
II. Fahrenheit or F
A. Freezing point = 32 F at 1 atmospheric pressure
B. Boiling point = 212 F at 1 atmospheric pressure
III. To convert from C to F use the formula
A.
 IV. To convert from F to C use the formula
A.

Metric Mass
I. Gram (g) is the standard unit
II. Nonmetric unit is the pound (lb)
III. 1 kg = 2.204 lb
IV. To convert lb to kg
A. kg = lb 2.204
V. To convert kg to lb
A. lb = kg 2.204
VI. 1 ton = 1000 kg or 2204 lb

DOSAGE CALCULATIONS
I. Definitions
A. Dose is the amount of medication measured (e.g., mg, mL, units [U])
B. Dosage is the amount of medication based on units per weight of animal (e.g., 50 mg/kg,
mL/kg, or tablets/kg)
C. The concentration of a drug is calculated by the manufacturer (e.g., mg/mL, mg/tablet)
II. To calculate the dose in milligrams (mg) use the following formula:
A. Dose (mg) = weight (kg) dosage (mg/kg)
B. Example: What is the dose if a patient weighs 30 kg and the dosage is 10 mg/kg?
C. Dose (mg) = 30 kg 10 mg/kg
D. Therefore dose = 300 mg
III. To calculate the dose in milliliters (mL) use the following formula:
A. Dose in mL = weight (kg) dosage (mL/kg)
B. Example: What is the dose if a patient weighs 25 kg and the dosage is 1 mL/10 kg
C. Dose (mL) = 25 kg 1 mL/10 kg
D. 25 kg /10 kg
E. Therefore the dose = 2.5 mL
IV. To calculate the dose in mL given the mg dose use the following formula:
A. Dose (mL) = dose (mg) concentration (mg/mL)
B. Example: What is the dose in milliliters (mL) of a drug, if the dose is 300 mg and the
concentration of the drug is 50 mg/mL?
C. Dose (mL) = dose (mg) concentration (mg/mL)
D. Therefore dose = 300 mg 50 mg/mL = 6 mL
V. To calculate the dose in tablets use the following formula:
A. Dose (tablets) = dose (mg) concentration (mg/tablet)
B. Example: What is the dose (in tablets) of a drug if the required dose is 100 mg and the
concentration of the drug is 50 mg/tablet?
C. Dose (tablets) = dose (mg) concentration (mg/tablet)
D. Dose = 100 mg 50 mg/tablet = 2 tablets
VI. Because drugs are manufactured in various concentrations, the milligram dose of a drug should
always be recorded in the patient file (rather than the administered dose or mL/tablets)
 A. Example: 1 mL of acepromazine maleate is administered to a patient. If the concentration
of acepromazine maleate is 10 mg/mL, the patient will receive 10 mg of the drug.
However, if the concentration of acepromazine maleate is 25 mg/mL, and the patient was
given 1 mL, the patient would have received 25 mg, or 2.5 times the prescribed amount

DILUTIONS AND SOLUTIONS

I. Definitions
A. Solution: mixture of substances made by dissolving solids in liquids or liquids in liquids
B. Solvent: solution capable of dissolving other substances
C. Solute: substance that is dissolved in a liquid
D. Dilution: reduction of a concentration of a substance
E. Diluent: agent that dilutes
II. When working with solutions/dilutions, the concentration of the substance is the amount of solute
dissolved in the solvent
III. Concentrations may be expressed as:
A. Volume per volume (or v/v) for liquids: percent volume in volume expresses the number of
milliliters of solute in 100 mL of solution
B. Weight per volume (or w/v): percent weight in volume expresses the number of grams (g)
(weight) of solute in 100 mL of solution (volume)
C. Weight per weight (or w/w) for solids: percent weight in weight expresses the number of
grams (g) of a solute in 100 g of solution
IV. Calculating the percent strength of a solution (w/v)
A. Use the formula: concentration (g/mL) = mass (g) volume (mL)
B. Example: What is the strength of a solution if 20 g of powder is dissolved in 500 mL of
liquid?
1. Concentration (g/mL) = mass (g) volume (mL)
2. Concentration = 20 g 500 mL = 0.04
3. To find percent multiply the concentration by 100 (0.04 100 = 4%)
C. Any of the quantities can be substituted in the equation (e.g., mass or volume or percent)
1. Variations in the formula include
a. Mass (g) = volume (mL) concentration (g/mL)
b. Volume (mL) = mass (g) concentration (g/mL)
D. Percent (w/v) means that there are a number of grams of solute in 100 mL of solution
1. Example: A 5% (w/v) solution means that there are 5 g of solute in 100 mL of
solution
2. A pure solution is assumed to be 100%, or 100 g of solution in 100 mL of solution
E. Concentration of a solution can also be expressed as a ratio. All of the following are
equivalent
1. 1:100 = 1 g/100 mL = 1% = 10 mg/mL
V. Calculating the strength of diluted solutions (v/v)
A. If a pure solution is diluted, the result is a stock solution
B. A weaker solution can be made by diluting it with solvent; however, a stronger solution
requires the preparation of a new solution or the addition of pure solution
C. Use the formula
 D. Example: Prepare 2 L of a 25% solution given a 50% solution and sterile saline
1. Substitute all known quantities and solve for the unknown (x)
a. Concentration of desired solution is 25%
b. Volume of the desired solution is 2000 mL or 2 L
c. Concentration of the stock solution is 50%
d. Volume of stock solution needed to prepare the solution is the unknown (x)

e. To calculate the amount of sterile saline or diluent to add to the 1000 mL of

50% solution to make 2000 mL of 25% solution
(1) Use the formula: diluent = volume of desired solution
volume of stock solution

(2) Therefore 1000 mL of 50% solution is added to 1000 mL of

diluent to prepare 2000 mL of 25% solution

PARTS PER MILLION

I. Parts per million (ppm) is defined as the number of parts of solute contained in 1 million parts of
solution. One part per million is 1 g solute in 1,000,000 mL or 1 part/10 6

A. Example: What is the ppm for a 0.6% solution?

B. Knowing that a 0.6% solution = 0.6 g/100 mL = x/1,000,000
1.

2.

3.
DRIP RATES
I. Use this formula

A. Volume of solution (mL) is the amount of solution to be administered

B. Drops/mL is the calibrated amount of an administration set determined by the company that
produces it
1. The drop/mL value is usually written on the administration set package
2. Most administration sets are calibrated at 10 drops/mL, 15 drops/mL or microdrip
of 60 drops/mL (NOTE: drop can be short formed to dr)
C. Time (seconds) is the amount of time that the fluids are to be administered
1. Time could be expressed as seconds, minutes, or hours; however, the drip rate is
usually expressed as drops/min
2. To calculate how many minutes there are in a value expressed in seconds, divide the
seconds by 60
D. Drip rate (drops/min) is the number of drops that are administered per 1 minute
E. Example: What is the drip rate if the volume of the solution is 1 L, the drops/mL = 20,
and the time is 4 hours?

(There are 60 minutes in 1 hour)

II. Variations on the formula include:

A. Time = (volume drops/mL) drip rate
1. Example: How long will it take for 2 L of normal saline to be administered to a
patient if the drops/mL is equal to 20 and the drip rate is 60 drops/min
2. Time = 2 L 20 drops/mL 60 drops/min
3. Before continuing, 2 L must be converted to 2000 mL
4. Therefore time = 2000 mL 20 drops/mL 60 drops/min
5. Time = 40,000 drops 60 drops/min
6. Final answer is time = 666.666 minutes = 11.11 hours = 11 hours,
6.6 minutes
B. Volume = (drip rate time) drops/mL
1. Example: How much normal saline can be administered if the drip rate is 60
drops/min, the veterinarian would like the patient to receive the fluids in 4 hours,
and the drops/mL is equal to 20?
2. First convert the time of 4 hours to 240 minutes
 3. Volume = 60 drops/min 240 minutes 20 drops/mL
4. Volume = 14,400 drops 20 drops/mL
5. Volume = 720 mL = 0.720 L

CONSTANT RATE INFUSION CALCULATIONS

I. Constant rate infusions (CRIs) are used for patients that require intravenous drugs (generally
analgesia) over a long period
II. When CRI drugs are given to a patient they are added to an appropriate volume of base solution,
which is often intravenous fluids
III. Example of CRI calculation
A. A 40-kg dog requires an intravenous infusion of 2% lidocaine. Calculate the amount of 2%
lidocaine that needs to be added to a 1-L bag of Normosol R, which is currently being
administered at 65 mL/hr. The 2% lidocaine CRI dose range for canines is 20 to
50 g/kg/min
B. Calculate the dose range for 2% lidocaine

C. Convert the minimum rate to an hour rate

D. Determine how many units of 2% lidocaine per mL of intravenous fluids

E. Determine how many units to add to a liter (L) bag of fluids

F. Determine how many mL of 2% lidocaine to add to the bag of fluids

Add 36.9 mL to a 1 L bag of Normosol R intravenous fluids

PRESCRIPTIONS
Guidelines
I. Excerpt from Principles of Veterinary Medical Ethics of the American Veterinary Medicine
Association
(https://www.avma.org/KB/Policies/Pages/Principles-of-Veterinary-Medical-Ethics-of-the-
AVMA.aspx#III)
A. The veterinarian-client-patient relationship
1. The veterinarian-client-patient relationship (VCPR) is the basis for interaction among
veterinarians, their clients, and their patients. A VCPR means that all of the following
are required:
a. The veterinarian has assumed the responsibility for making clinical
judgments regarding the health of the patient, and the client has agreed to
follow the veterinarians' instructions
b. The veterinarian has sufficient knowledge of the patient to initiate at least a
general or preliminary diagnosis of the medical condition of the patient.
This means that the veterinarian is personally acquainted with the keeping
and care of the patient by virtue of a timely examination of the patient by the
veterinarian, or medically appropriate and timely visits by the veterinarian
to the operation where the patient is managed
c. The veterinarian is readily available for follow-up evaluation or has arranged
for veterinary emergency coverage and continuing care and treatment
d. The veterinarian provides oversight of treatment, compliance, and outcome
e. Patient records are maintained
2. When a VCPR exists, veterinarians must maintain medical records. Dispensing or
prescribing a prescription product requires a VCPR
a. Veterinarians should honor a clients request for a prescription in lieu of
dispensing
b. Without a VCPR, veterinarians merchandising or use of veterinary
prescription drugs or their extra-label use of any pharmaceutical is unethical
and is illegal under federal law
II. A prescription drug can only be dispensed by the order of a licensed veterinarian within the course
of his or her professional practice where a valid VCPR exists

Veterinary Technicians Role in Dispensing Medications

I. The technician should not issue or refill medications without the veterinarians approval
A. If medication is dispensed by a technician, this is in violation of federal law
II. The ultimate responsibility for any medication dispensed lies with the prescribing veterinarian
A. Technicians may only prepare labels, count tablets, pour medication, attach labels, and price
the dispensed medication

Prescription Labels
I. Even though most prescription labels are now generated by a computer, the label should be checked
for accuracy before dispensing the drug
II. The label should contain the following information
A. Name, address, and telephone number of the clinic
B. Prescribing veterinarians name
C. Name of patient and clients last name and the species in some provinces and states
 D. Name of drug
E. Concentration of drug and amount of drug dispensed
F. Date
G. The drug identification number (DIN) (check provincial or state regulations to determine if
required)
H. Refills should be noted
I. Specific instructions (sig)
1. No abbreviations should be used
a. Example: b.i.d. should be written as two times a day or every 12 hours
2. If the medication is for the left or right eye, it should be noted on the label
3. If the drug should be administered with food or without food, it should also be
noted
4. The instructions should be clearly typed
J. The vial may also need additional labels, such as
1. For veterinary use only
2. Keep refrigerated
3. Keep out of reach of children
4. Withdrawal time
5. Shake well
6. Do not use after [date]
7. Poison
8. External use only
K. A childproof container may be necessary to comply with state or provincial laws
1. The vial may also need to be amber in color to prevent the breakdown of some drugs
caused by ultraviolet light
III. Also see Appendixes A and B for further information

REVIEW QUESTIONS
1. How much sterile water is needed to make a 4% solution using 1 g of drug?
a. 25 mL
b. 400 mL
c. 100 mL
d. 50 mL

2. Convert 6 mm to m:
a. 0.006 m
b. 0.000006 m
c. 6000 m
d. 600 m

3. Given a 45% solution and sterile diluent, how would you prepare 3 L of 15% solution? Take:
a. 200 mL of 45% and add 2000 mL of sterile diluent
b. 1000 mL of sterile diluent and add 2 L of 45% solution
c. 1000 mL of 45% solution and add 2 L of sterile diluent
d. 2 L of water and add 4.5 L of 45% solution
4. A previous client calls to report that her new pet needs some antibiotics. She will be by in 1 hour to
pick up the prescription. What should the technician do?
a. Explain to the client that a veterinarian must examine the animal before any medication can be
dispensed
b. Explain to the client that a technician cannot dispense medication and suggest that the client speak
with the veterinarian
c. Explain to the client that antibiotics require a prescription to be dispensed
d. All of the above

5. Given the following information: 1987 mL of saline at 15 drops/mL over an 8-hour period, the
approximate drip rate should be:
a. 10.3/10 sec
b. 1.05/10 sec
c. 20/10 sec
d. 1.92/sec

6. Given a pure solution, how would you make 500 mL of 50% solution?
a. Add 500 mL of 100% solution to 500 mL of water
b. Add 100 mL of sterile water to 400 mL of pure solution
c. Add 5000 mL of sterile water to 500 mL of 50% solution
d. Take 250 mL of pure solution and add 250 mL of sterile water

7. What is the concentration (mg/mL) and percentage of the following solution (w/v): 5 g added to
200 mL of sterile water:
a. 25 mg/mL, 2.5%
b. 250 mg/mL, 2.5%
c. 50 mg/mL, 5%
d. 4 mg/mL, 40%

8. What is the percent of the final solution (v/v) if 30 mL of solution is added to 70 mL of water?
a. 30%
b. 100%
c. 10%
d. 3%

9. A dog weighs 20 kg, the dose rate is 5 mg/kg, and the tablet size is 50 mg. The prescription
reads 100 mg bid for 10 days a.c. How many tablets are needed for 1 dose and for a 24-hour
period?
a. 2 tablets, 8 tablets
b. 1 tablet, 2 tablets
c. 2 tablets, 4 tablets
d. 4 tablets, 8 tablets

10. How would you prepare 1.5 L of a 1:200 (w/v) solution given a 12% solution and sterile water?
Take:
a. 625 mL of the 12% solution and add 875 mL of sterile water
 b. 1437.5 mL of the 12% solution and add 62.5 mL of sterile water
c. 62.5 mL of the 12% solution and add 1 437.5 mL of sterile water
d. 875 mL of 12% solution and add 635 mL of sterile water

11. A 26-kg patient requires a premixed preanesthetic solution at a dose rate of 1 mL/10 kg. The
animal also needs propofol induction anesthetic drawn up at the dose rate of 1 mL/4 to 5 kg. The
atropine emergency dose is 0.02 to 0.04 mg/kg. The concentration of atropine is 0.5 mg/ mL.
Calculate the required dose for these drugs.
a. Preanesthetic 2.6 mL, propofol 5.2 to 6.5 mL, atropine 1.04 to 2.08 mL
b. Preanesthetic 26 mL, propofol 10.4 to 13 mL, atropine 2.08 to 4.08 mL
c. Preanesthetic 0.26 mL, propofol 1.04 to 1.3 mL, atropine 0.2 to 0.4 mL
d. Preanesthetic 260 mL, propofol 5.5 mL, atropine 0.2 mL

12. What is the ppm for a 0.3% solution?

a. 30 ppm
b. 3000 ppm
c. 300 ppm
d. 3 ppm

13. Convert 5% to mg/mL.

a. 5 mg/mL
b. 500 mg/mL
c. 50 mg /mL
d. 500 g/100 mL

14. Convert 27.5 kg to lb.

a. 60.5 lb
b. 12.5 lb
c. 123.75 lb
d. 55 lb

15. If an animal was given 0.3 mL of 25 mg/mL Atravet before an ECG, what should the technician
write on the ECG tracing?
a. 0.3 mL of Atravet
b. 3 mg of Atravet
c. 0.75 mg of Atravet
d. 7.5 mg of Atravet

16. A veterinarian writes a prescription for a technician to dispense on April 8. R 2 tabs qid for 2 d
x

then 1 tab sid for 10 d or prn po a.c. Recheck in 1 month. What should be written on the dispensing
label?
a. Take 2 tabs every 4 hours for 2 days than 1 tab every other day for 10 days. Recheck in 1
month.
b. Take 2 tablets 4 times a day for 2 days than 1 tablet once a day for 10 days as required before
meals. Recheck May 8.
 c. Take 2 tabs by mouth every 2 days than 1 tab every single day for 10 days with food. Recheck
in 1 month.
d. Give the dog 1 tab every 4 days than 1 tab every day for 10 days after it has eaten and before it
drinks. Call us to recheck in 1 month from the time tabs are gone.

17. Barney, a 43-kg Rottweiler, is in recovery after a laparotomy. The doctor orders a fentanyl
(50 g/mL) CRI at 5 g/kg/hr. The fluid volume is set at 95 mL/hr. How much fentanyl will you
add to 1000 mL of 0.9% sodium chloride?
a. 2150 g/hr or 45.2 mL
b. 215 g/hr or 45.2 mL
c. 4085 g/hr or 452 mL
d. 215 g/hr or 450.2 mL

18. A 23-kg dog requires 550 mL of fluid to be administered over the next 24 hours to replace losses
and 500 mL of fluid for maintenance. The administration set delivers 20 drops/per mL. Calculate the
drip rate.
a. 15 drops/min
b. 0.15 drops/min
c. 416.66 drops /min
d. 21.53 drops/min

19. The prescription for Lucy is as follows: sig.3 gtt OS q4h for 3 days and prn. NR. The technician fills
the prescription and writes the following on the label:
a. Give Lucy 3 drops in left eye every 4 hours for 3 days. Then as needed. No Repeats.
b. Give Lucy 3 drops in right eye 4 times a day for 3 days only as needed.
c. 3 drops in right eye for 4 days every 3 hours until finished. No Repeats.
d. 3 drops in left eye for 3 days as needed. No Repeats.

20. A vial contains 80 mg of drug in 2 mL of injection. How many mL of the injection should be
administered to obtain 0.02 g of drug?
a. 1.0 mL
b. 2.0 mL
c. 1.5 mL
d. 0.5 mL

CHAPTER 21

Anesthesia
PREANESTHETIC ASSESSMENT
The following assessments will determine if there are any potential problems or concerns for the procedure
scheduled and/or anesthesia administered.
I. Patient identification
A. A hospital identification band includes the patients name and hospital number
B. The patient signalment includes the species, breed, age, sex, body weight, and temperament
II. Patient history (see Chapter 24)
A. The patients history will reveal
1. The duration and nature of the illness
2. Any concurrent diseases (e.g., vomiting, diarrhea, heart murmur, renal failure,
epilepsy)
3. The patients activity level or exercise tolerance
4. Previous or current medication and drug history
5. Any previous anesthesia problems (e.g., prolonged recovery or excitement)
6. The patients last feeding
7. Vaccination history
III. Physical examination
A. To obtain information on the patients health
B. The general body condition of the patient (e.g., obese, cachexia, dehydrated)
C. Cardiovascular system (e.g., heart rate, rhythm)
D. Pulmonary system (e.g., respiratory rate, mucous membrane color, breath sounds)
E. Hepatic function (important for metabolism and excretion of anesthetic drugs)
F. Renal disease (e.g., anuria, oliguria, polyuria/polydipsia)
G. Gastrointestinal (GI) disease (e.g., diarrhea, vomiting)
H. Neurological dysfunction (e.g., seizure history)
IV. Diagnostic tests
A. Diagnostic tests are selected based on the history and physical examination of the patient
B. Each veterinary clinic will have policies that stipulate certain tests, which are based on the
preoperative condition of the patient, that are to be completed before anesthesia
C. Diagnostic tests that will provide information for anesthetic assessment include complete
blood count, blood chemistries, urinalysis, blood clotting tests, electrocardiogram, and
radiographs (possibly magnetic resonance imaging, computed tomography scan, and/or
ultrasound)
V. Anesthetic risk
A. After the preanesthetic assessment is completed, a classification of the patients physical
status can be determined
B. The American Society of Anesthesiologists integrates a scale system that categorizes a
patient into classes based on the evaluation of anesthetic risk
1. Each class defines the anesthetic risk involved with the anesthesia and/or procedure
(Table 21-1)

TABLE 21-1
American Society of Anesthesiologists (ASA) Scale

Category Description Examples

I
Category Description Examples

Minimal risk Normal, healthy patient Ovariohysterectomy, castration

II

Slight risk Mild systemic disturbances Ruptured cruciate ligament, neonate,

geriatric patient

III

Moderate risk Moderate systemic disturbances or disease with mild Anemia, fever, heart murmur, moderate
clinical signs dehydration

IV

High risk Severe systemic disturbances that are life threatening Shock, severe dehydration, fever, gastric
torsion with arrhythmias

V
Category Description Examples

Extreme Submitted for surgery in desperation but little chance Advanced multiple organ failure, shock,
risk/moribun of survival. Patient not expected to live 24 hr severe trauma
d

Emergency Any of the above classes presented for immediate

surgery
VI. Selection of the anesthetic protocol
 A. The final preparation for anesthesia is selecting an anesthetic protocol that is based on the
information collected from the preanesthetic assessment. It is important to select the
anesthetic drug, dose, and route based on the assessment information

PREANESTHETIC DRUGS
I. Indications
A. Preanesthetic agents are drugs administered before general anesthesia
B. The preanesthetic patient assessment and the evaluation of anesthetic risk will determine the
selection of preanesthesia drugs required
II. Advantages
A. Reduce anxiety and calm patients by producing mild to moderate sedation
B. Facilitate smooth and safe induction, maintenance anesthesia, and recovery from anesthesia
C. Decrease the amount of induction agent and inhalant anesthesia agent required
D. Provide analgesia for preoperative, intraoperative, and postoperative phases
E. Provide muscle relaxation
F. Reduce secretions
G. Tranquilize and/or sedate patient for safe handling
III. Disadvantages
A. Disadvantages are minimal
B. Cost is a common concern. However, the higher cost can be offset by the reduction in the
amounts of induction and inhalant agents required
C. Time constraints can be a factor. However, depending on the route of administration, the
time frame may not be a factor, considering the previously mentioned advantages of
administering preanesthetic drugs
1. For example, preanesthetics given subcutaneously (SC) usually take 20 minutes to
reach peak effect but can last longer than intramuscularly (IM) and intravenously (IV)
administered drugs
2. Most premedication can be given SC, IM, or, with caution, IV
D. Some drugs have been associated with temporary behavior changes (e.g., xylazine,
acepromazine, opioids, and benzodiazepines)
IV. Examples of preanesthetics
A. Preanesthetic drugs include:
1. Anticholinergics
2. Tranquilizers and sedatives
3. Opioids
4. Neuroleptanalgesics

CLASSIFICATIONS OF PREANESTHETIC DRUGS

Anticholinergics
I. Anticholinergics are parasympatholytic drugs that exert their effects by blocking the actions of the
parasympathetic neurotransmitter acetylcholine at the muscarinic receptors
A. Two examples commonly used in veterinary medicine are atropine and glycopyrrolate
B. Both drugs can be administered IV, IM, or SC
II. Indications and side effects
A. Prevent or treat bradycardia caused by vagal reflexes (e.g., surgical manipulation) or by
anesthetically administered drugs (e.g., opioids and -agonists)
2

B. Increase heart rate by competitively antagonizing acetylcholine

 1. Increases in heart rate generally increase cardiac output and blood pressure
C. May initially cause sinus tachycardia
D. When given IV, may initially cause first-degree or second-degree atrioventricular block
before sinus tachycardia
E. Can be administered in combination with opioids and sedatives as part of the preanesthetic
drug protocol
F. Reduce salivary and tear secretions
G. Promote bronchodilation
H. Dilate pupils (mydriatic)
I. May produce thicker mucous secretions in the airway, especially in the cat and horse
J. Reduce GI activity by inhibiting peristalsis
K. May not be necessary but should be considered in neonates who have existing
underdeveloped sympathetic nervous system and therefore rely on the sympathetic
stimulation (e.g., heart rate) to maintain cardiac output
III. Contraindications
A. Patients with preexisting tachycardia and existing cardiac diseases
1. Anticholinergics may induce tachycardia and therefore may be contraindicated in
patients with cardiovascular disease (e.g., cardiomyopathy)
B. Possibly geriatric patients (e.g., decreased function of physiological organ systems) or
patients with other conditions (e.g., pulmonary edema) that could not handle potential
tachycardia
C. Conditions, such as constipation or ileus, that would further reduce peristaltic action of the
intestine (e.g., in endoscopy procedures and upper GI barium series)
D. Colic may develop in horses and bloat in ruminants; therefore, agent type and dose are
cautiously selected
IV. Atropine
A. Higher lipid solubility than glycopyrrolate; therefore, more potent and faster acting
B. Will cross the blood-brain barrier and will cross the placental barrier in pregnant patients
C. Atropine IV may cause ventricular arrhythmias
D. Atropine overdose can be reversed with physostigmine. Signs of atropine toxicity include
drowsiness, excitement, and potential seizures
V. Glycopyrrolate
A. Slower onset of action and generally has less potential for producing tachycardia or cardiac
arrhythmias than atropine
B. Lasts longer than atropine
C. Will not cross the blood-brain barrier and will not cross the placental barrier in pregnant
patients

Tranquilizers and Sedatives

I. A tranquilizer is a drug that calms an anxious patient by reducing anxiety but will not necessarily
reduce awareness
II. A sedative is a drug that reduces excitement or irritability by causing sleepiness and decreased
mental activity
A. Examples of tranquilizers and sedatives are phenothiazines, benzodiazepines,
butyrophenones, and -agonists
2

III. Tranquilizers and sedatives are used in anesthetic protocols to:

A. Sedate and reduce anxiety
B. Smoothen inductions and recoveries
C. Reduce anesthetic induction and inhalant drugs
IV. Examples of tranquilizers and sedatives
A. Phenothiazines
1. Examples include acepromazine, chlorpromazine, and promazine
2. The mechanism of action involves the blockade of D dopamine receptors in the
2

brain, thereby producing sedation and tranquilization

3. Indications and side effects
a. Acepromazine is most commonly used in veterinary medicine and approved
for use in both small and large animals
b. Can be administered SC, IM, or IV
c. Dose and route are dependent on the patients preanesthetic assessment
d. Are water soluble and can be mixed with other water-soluble drugs (e.g.,
hydromorphone and acepromazine together will produce neuroleptic
analgesia)
e. Used as tranquilizers and sedatives
f. Skeletal muscle relaxation
g. Antiarrhythmic effect
h. Antiemetic effect
i. May lower the seizure threshold
j. Antihistamine effect
k. Hypothermia through depressing the thermoregulatory center
l. Hypotension (dose dependent) through peripheral vasodilation
m. Inhibit platelet aggregation
n. May produce hematological effects such as decreasing patients
hematocrit (dogs, horses)
o. No analgesic properties
p. May cause excitement rather than sedation
q. Personality changes that usually subside within 48 hours
r. May produce penile protrusion and prolapse (priapism) in horses; however,
the severity and duration of prolapse are dose dependent
4. Contraindications
a. Shock, hypovolemia, dehydration, and hypothermia conditions, which have
existing peripheral vasodilation compromise: phenothiazines can further
exacerbate vasodilation and hypotension
b. Seizing/epileptic patients, seizure history, or head trauma
c. Depressed patients
d. Caution with geriatric and pediatric patients; use a lower dose or consider
alternative agents, such as benzodiazepines
e. Use with caution in patients with liver or kidney disease
f. Allergy testing because of their antihistamine effect
g. Avoid in breeding stallions
B. Benzodiazepines
1. Examples of benzodiazepines are diazepam (Valium), midazolam (Versed),
lorazepam (Ativan), and zolazepam
2. The mechanism of action involves binding to a specific site on the -aminobutyric
acid (GABA) receptor in the brain
a. Benzodiazepines enhance the activity of central nervous system (CNS)
inhibitory neurotransmitters (-aminobutyrate and glycine) and open
chloride channels, which cause hyperpolarization of cell membranes. This
results in decreased neural activity
 b. Diazepam is not water soluble and contains propylene glycol, and therefore
should not be mixed with other drugs or administered IM
c. Midazolam and zolazepam are water soluble and can be administered either
IM or IV
d. Flumazenil is a benzodiazepine antagonist drug, which is used to reverse
any unwanted effects of the benzodiazepines
3. Indications and side effects
a. Calming effect (tranquilizers)
b. Minimal cardiovascular and respiratory effects; therefore, indicated for use
in geriatric, pediatric, and other moderate- to high-risk patients
c. Anticonvulsants
d. Muscle relaxants
e. Sometimes given IV to sedated patients to enhance sedation or reduce the
dose of induction agent
f. When combined with ketamine, work effectively as induction agents
g. Inhalant-sparing properties (reduce inhalant anesthetic requirements)
h. May produce bradycardia and hypotension if rapidly administered IV
i. Diazepam increases appetite in most species (cats, ruminants)
j. Ideal for older, depressed, or anxious patients
4. Contraindications
a. Normal, excitable, healthy animals may not be sedated or tranquilized with
benzodiazepines; therefore, these drugs may cause excitement in some
patients
b. Drugs are metabolized in the liver, and therefore should be avoided in
patients with poor hepatic function
c. Ataxia and excitement are evident in large animal species (horses); therefore,
a preanesthetic medication (e.g., xylazine) is recommended. An induction
agent immediately follows diazepam. This will not only provide muscle
relaxation and induction quality, it will avoid any potential excitatory effects
C. Butyrophenones
1. The two butyrophenones commonly used in veterinary medicine are azaperone
(Strensil) and droperidol (Inapsine)
a. Butyrophenones structurally resemble and evoke pharmacologic effects
similar to those of the phenothiazines
b. The main effects in the CNS are by the blockade of D dopamine receptors
2

and mild -adrenergic blockade

c. Most common use of butyrophenones in veterinary medicine is in swine and
exotic animal fields
d. Both drugs are administered IM
2. Indications and side effects
a. Dopamine antagonists
b. Reduce anxiety
c. Antiemetics
d. Reduce movement and response to stimuli
e. Very high doses can cause rigidity and seizures
f. Hypotension effects due to peripheral vasodilation caused by -adrenergic
blockade
g. Cardiovascular effects: bradycardia and decreased cardiac output
h. Increase respiratory rate or sometimes cause panting
 i. Hypothermia
j. Produce salivation
3. Azaperone
a. Has similar physiological effects to those of droperidol
b. It is primarily used to sedate and treat aggression in swine
c. Drug produces muscle relaxation but does not have analgesic properties
d. For immobilization or anesthesia for various procedures or diagnostics,
azaperone can be used in combination with other drugs (e.g., opioids or
ketamine)
4. Droperidol
a. Produces muscle relaxation but does not have analgesic properties
b. Can be combined with opioid fentanyl citrate to produce a
neuroleptanalgesic: Innovar-Vet (available for use in some countries; not in
Canada)
D. -Agonists
2

1. Examples of -agonists commonly used in veterinary medicine are xylazine

2

(Rompun, AnaSed), romifidine (Sedivet), and dexmedetomidine (Dexdomitor)

2. The drugs stimulate -adrenoceptors, causing a decrease centrally and peripherally
2

of norepinephrine release, which produces CNS depression and decreased

catecholamine release
3. Indications and side effects
a. Produce calming effect
b. Provide profound sedation
c. Moderate analgesia
d. Muscle relaxation
e. Reduction in dose of induction and inhalant agents when used as
preanesthetic drugs
f. Side effects
(1) Profound cardiovascular effects include bradycardia, decreased
cardiac output, and dysrhythmias (e.g., first-, second-, and third-
degree heart block)
(2) Produce initial increase in blood pressure (hypertension) due to
systemic vascular resistance, vasoconstriction, and bradycardia. This
is transient and the blood pressure will eventually normalize
(3) Longer period of hypotension is noted after the initial hypertension
due to the decrease in release of norepinephrine. If hypotension
persists, the -agonist can be antagonized
2

(4) Profound peripheral vasoconstriction (pale mucous membranes)

(5) Avoid -agonists in patients that have cardiovascular disease or
2

systemic compromise
(6) Dose-dependent respiratory depression is common; therefore,
ventilation may be required
(7) Hypothermia
(8) Can depress swallowing reflex (e.g., caution in patients with
laryngeal paralysis)
(9) Other side effects may include
(a) Vomiting (some species)
(b) Slight muscle tremors
(c) Excitement
 (d) Reduced intestinal motility
(e) Diuresis (increases in water and sodium excretion)
g. -Agonists suppress insulin release; therefore, they may cause
2

hyperglycemia and glucosuria

h. Associated with temporary behavior changes
4. Addition of an opioid with an -agonist will enhance sedation and analgesia
2

5. Contraindications
a. Cardiovascular disease
b. Respiratory disease
c. Hepatic and/or renal disease
d. Diabetes
e. Shock conditions
f. Gastric dilation and torsion (dehydration)
6. Xylazine
a. Most commonly used tranquilizer in veterinary medicine for both large and
small animals until the early 1990s
b. Sedative effects last 1 to 2 hours
c. Analgesic effects last approximately 30 minutes
d. Gastrointestinal function (e.g., vomiting in cats and dogs); gastric distention
(large-breed dogs)
e. Somatic and visceral pain relief noted in horses
f. Can be administered alone or with local anesthetic (e.g., lidocaine)
epidurally in horses
g. Generally used for large animals
(1) Caution in ruminants: may cause decreased oxygen exchange
(2) Used in ruminants but in much lower doses
(3) Causes decrease in GI motility and transit time in many species
7. Romifidine
a. Produces reliable sedation and analgesia (horses)
b. More potent than xylazine
c. Less ataxia seen with romifidine compared to equivalent doses of xylazine
and dexmedetomidine
d. Used mostly in horses
e. Provides longer sedation than xylazine and dexmedetomidine
f. More profound bradycardia and second-degree heart block than with
xylazine
8. Dexmedetomidine
a. Newest -agonist approved for veterinary use (dogs and cats); has greater
2

affinity for the -adrenoceptors (mediates the sedation effects)

2

b. It is the active form of medetomidine and has twice the potency of

medetomidine
c. Sedative, analgesic, muscle relaxant, and chemical restraint properties
d. Similar cardiovascular contraindications to those caused by -agonists;
2

however, may be less pronounced because of lower recommended doses

e. Mild respiratory effects
f. Can be used alone or in combination with an opioid to produce a more
profound sedation (e.g., minor procedures or diagnostics)
g. Can be used in combination with a dissociative anesthetic (ketamine) to
produce anesthesia
 h. Dose-sparing effect on induction and maintenance anesthesia drugs. This is
proportional to the dexmedetomidine dose administered
i. Route: intramuscular, intravenous, and constant rate infusion (CRI)
j. Dexmedetomidine can be used as a CRI adjunct during general anesthesia as
well as for pain management intra- and postoperatively via CRI (dogs)
E. -Antagonists ( -agonist reversal agents)
2 2

1. Yohimbine (Yobine) and tolazoline (Priscoline) can reverse the effects of xylazine and
dexmedetomidine
2. Atipamezole (Antisedan) is specific to dexmedetomidine

Opioids (Table 21-2)

TABLE 21-2
Summary of Opioids

Analgesic potency Duration of

Administration Analgesic
Drug relative Receptor Classification analgesi
route effects
to morphine a

Morphine 1 Mu Agonist SC, IM, IV 3-6 hr Moderate to

severe
pain

Codeine 0.1 Mu Agonist Oral 3-6 hr Moderate to

severe
pain

Hydromorphon 5 Mu Agonist SC, IM, IV 3-6 hr Moderate to

e severe
pain

Meperidine 0.1 Mu Agonist SC, IM 1-2 hr Mild to

moderat
e pain

Fentanyl 100 Mu Agonist SC, IM, IV 20-30 min Moderate to

severe
 Analgesic potency Duration of
Administration Analgesic
Drug relative Receptor Classification analgesi
route effects
to morphine a

pain

Butorphanol 3-5 Kappa, mu Agonist- SC, IM, IV 1-2 hr Mild to

antagonis moderat
t e pain

Buprenorphine 30 Partial mu Partial agonist SC, IM, IV 6-8 hr Mild to

moderat
e pain

Pentazocine 1/3 Partial mu Agonist- IM, IV 1-2 hr Mild to

and antagonis moderat
kappa t e pain
I. Opioids can be classified based on which opioid receptor they act on in the brain or spinal cord,
which produces a variety of effects such as sedation, analgesia, dysphoria, and/or excitement
A. Often the term opiate is used synonymously with opioid
B. Opiates are a group of natural alkaloid agents that have been extracted from the poppy
(Papaverum somniferum) and purified (e.g., morphine and codeine)
C. Synthetic (e.g., hydromorphone) and semisynthetic (e.g., buprenorphine) analogs have been
developed for their effective analgesic properties for use in clinical veterinary medicine
D. Opioid receptors include mu (), delta (), and kappa (), which are located in the CNS
mainly in the presynaptic membrane of pain pathways, cough center, and centers associated
with respiration and nausea
E. Their stimulation inhibits the release of neurotransmitters from the presynaptic cell, which
impedes pain transmission
II. Opioids have strict regulations and are classified as Schedule I drugs under the Controlled Drugs
and Substance Act, which is Canadas federal drug control statute; most are classified as Schedule
II drugs under the Controlled Substances Act in the United States
III. Opiates are also characterized as narcotics, which are addictive drugs derived from opium or
opium-like (synthetic) compounds that produce analgesic properties and narcosis
IV. Classification of opioids
 A. Pure (mu) agonists include morphine, meperidine, hydromorphone, and fentanyl, which
stimulate all opioid receptors
1. There is a full range of physiological responses that occur with each opioid drug;
however, responses depend on the type of drug, dose, and species of patient.
Therefore, selection is based on the patients preanesthetic assessment
B. Mixed agonists-antagonists include butorphanol, buprenorphine, and pentazocine, which
block one type of receptor and stimulate another type of receptor
C. Pure antagonists, such as naloxone, will reverse the effects of pure and mixed agonists with
very little clinical effect on their own
1. Reversal occurs because the antagonist has a higher affinity than the opioid at the
specific receptor site
2. It is possible to titrate naloxone dose to remove side effects while maintaining
analgesic properties of the opioid
V. Clinical effects of opioids
A. Act by reversible combination with one or more specific receptors in the brain and spinal
cord
B. Produce a variety of effects, such as analgesia, sedation, dysphoria, euphoria, and excitement
C. Can be combined with a tranquilizer to induce neuroleptanalgesia (e.g., morphine plus
acepromazine)
D. Commonly used as an analgesic in preanesthetic medications, as an induction agent, or
intra- and postoperatively for balanced anesthesia and preemptive pain control
1. Decrease amount of induction drugs and inhalant anesthesia agents required
2. Have minimal cardiovascular depressant effects
E. The physiological effects are reversible with narcotic antagonists
F. Analgesic effect is mild to profound, based on the classification of the opioid, and dose and
route administered
G. Can cause bradycardia
H. Respiratory effects include panting in dogs; opioids cause the thermoregulatory center in the
brain to reset itself
1. Respiratory depression is dependent on dose and whether it is combined with other
potent respiratory depressants during general anesthesia
I. May cause hypothermia; however, this is noted in combination with other drugs used
J. Hyperthermia may occur in cats that are administered hydromorphone (mechanism is not
clearly known)
K. Nausea, vomiting, and defecation (dose dependent) especially noted with morphine and
hydromorphone
L. Constipation may occur from prolonged GI stasis
M. Mild muscle relaxation
N. Cough suppression
O. Addiction
P. Salivation
Q. Miosis (dogs and pigs) and mydriasis (cats and horses)
R. Increased responsiveness to noise
S. Sweating, particularly in the horse
T. Morphine and meperidine may cause histamine release when administered IV. This results in
vasodilation and hypotension
U. Excitement occurs if given rapidly IV
1. Horses and cats are particularly susceptible to the excitatory effects. Give morphine
at very low doses in cats
 VI. All opioids are water soluble
VII. Contraindications
A. Previous history of excitement
B. Morphine has higher incidence of inducing vomiting (depending on the dose). Therefore,
avoid use with cases of GI obstruction or diaphragmatic hernia
VIII. Route of administration: intravenous, intramuscular, subcutaneous
A. Other routes for opioids include oral, transdermal patch (e.g., fentanyl), epidural (e.g.,
morphine), and CRI (e.g., fentanyl, morphine)
B. Transdermal route of administration: fentanyl patch
1. Fentanyl is highly lipid soluble; therefore, it can be absorbed through the skin
2. Fentanyl is available in various concentrations (e.g., 25 g, 50 g, 75 g)
3. Provides continuous steady-state analgesia for 3 to 5 days
4. Takes 8 to 12 hours to become effective
5. Very few cardiovascular effects and does not significantly contribute to vasodilation
or hypotension
6. Contraindications include:
a. Hypersensitivity to fentanyl or adhesives
b. Suspected or existing increased intracranial pressure
c. Central hypoventilation
d. Renal or hepatic dysfunction
e. Fever
7. Precautions and concerns
a. Heating pads can increase transdermal fentanyl uptake (overdose can occur)
b. Suboptimal dose due to poor skin contact, and unexpected high dose (e.g.,
from high body temperature or a patch that is too large for patient), which
can cause marked sedation, narcosis, or inappetence
c. Accidental exposure of humans to the fentanyl in the patch; therefore, wear
gloves to apply and remove patch
d. Client education is very important in the proper handling and disposal of
fentanyl patches due to potential fentanyl concentration remaining in the
patch as well as potential human abuse. Demonstrate to the client how to
remove the patch using gloves and have client return it to veterinary clinic or
nearby pharmacy. Keep out of reach of children and household pets

Neuroleptanalgesics
I. Any combination of an opioid analgesic (e.g., morphine, meperidine, hydromorphone, butorphanol)
and a tranquilizer (e.g., acepromazine, dexmedetomidine, diazepam)
A. This combination will enhance the CNS depressant effects of each drug
B. Provide hypnosis and analgesia
II. Drugs can be mixed in same syringe or administered separately (IM or IV)
A. Commercially made drugs used to induce neuroleptanalgesia, such as Innovar-Vet
(fentanyl/droperidol), are available in some countries
III. Opioid component can be reversed with opioid antagonist (e.g., naloxone) or mixed agonist-
antagonist (e.g., butorphanol can reverse the effects of morphine)
A. Some of the other tranquilizer components cannot be reversed (e.g., phenothiazines, other
non-opioid drugs)
IV. Indications
A. Need for heavier sedation (depending on dose) for short procedures (e.g., wound suturing,
porcupine quill removal)
 B. Cardiac or shock cases
V. Contraindications
A. Patient will become hyperactive to auditory stimulus. Need a quiet environment
B. Respiratory depression (opioid dose dependent)
C. Some patients may pant (temperature-regulating center of the brain interprets that the
normal body temperature is being elevated) because of opioid effect
D. Opioid may cause defecation, vomiting, or flatulence
E. Bradycardia (dose-related effect of the opioid)
F. Morphine and meperidine injected IV may cause histamine release
G. Miosis in dogs and mydriasis in cats
H. Excessive salivation
I. Ataxia
J. Excitement

INJECTABLE ANESTHETIC DRUGS

I. Indications
A. Administration of anesthesia drugs followed by inhalant agents
B. As anesthetic agents for short, minor procedures (e.g., suturing, radiographs)
C. Administered by repeated boluses or by infusion, such as total intravenous anesthesia (TIVA)
D. Supplement to inhalant agents
E. Can provide long-term sedation (e.g., patients in intensive care unit)
II. Advantages
A. Rapid onset and recovery
B. Simple, require little equipment (except for infusions)
C. Drugs do not irritate airways
D. Minimal adverse effects on cardiovascular and respiratory systems (dose dependent)
E. Provide analgesia and good muscle relaxation
III. Disadvantages
A. Difficulty in catheterization (e.g., patient with fibroses in peripheral veins)
B. Intravenous drugs, and therefore may be difficult to maintain if there is no intravenous
catheter in place
C. Some drugs are irritants if given perivascularly
D. Drugs cannot be removed once they are injected
E. Cumulative effect of the drugs
F. Risk of airway complications if the patient is not intubated (e.g., aspiration)
G. May cause induction apnea
H. May cause hypotension
I. May cause excitement on induction or recovery

CLASSIFICATIONS OF ANESTHETIC DRUGS

Barbiturates
I. Classification of barbiturates
A. Based on the chemical substitutions on the barbituric acid molecule and the duration of
action
B. CNS depression by acting on CNS neurons and aminobutyric acid (GABA ) receptors
A

C. Various degrees of CNS depression can produce drowsiness, mild to moderate sedation, and
general anesthesia
II. Chemical classifications
A. Oxybarbiturate
1. Pentobarbital sodium (Nembutal, Somnotol), barbital, and secobarbital
2. Short acting (45 to 90 minutes)
B. Thiobarbiturate
1. Thiopental sodium (Pentothal)
2. Ultrashort acting (5 to 15 minutes)
C. Methylated oxybarbiturate
1. Methohexital (Brevital)
2. Ultrashort acting (5 to 10 minutes)
III. Indications and side effects
A. Factors such as patients assessment and preanesthetic evaluation will determine drug
type and dose
B. Sedation
C. Anticonvulsants
D. General anesthesia
1. Commonly used as induction agents to allow endotracheal intubation followed by
maintenance with an inhalant anesthetic, such as isoflurane
2. Cause unconsciousness at an adequate dose
3. Give to effect (amount necessary to induce anesthesia)
4. Give a bolus (usually one third to one half of the calculated dose given rapidly)
E. Nonreversible
F. Respiratory and cardiovascular depressants to varying extents (dose related)
G. Protein binding
1. Level of plasma protein can alter the rate and amount of absorption of the
barbiturates
2. Barbiturates will bind to protein; therefore, the amount of barbiturate free in the
circulation and not bound to protein will increase if the patient is hypoproteinemic
3. With low level of plasma protein, more barbiturate will be available to penetrate the
CNS and cause unconsciousness
H. Lipid solubility
1. Increases in the barbiturates from the long acting to the ultrashort acting
2. There is a quicker onset of action with the shorter acting barbiturates because they
cross the blood-brain barrier faster. This also accounts for the quicker recovery from
the shorter acting barbiturates
3. Recovery from these drugs depends on a combination of redistribution (to muscle
and fat) and hepatic metabolism
a. If a drug has low lipid solubility, there is little or no redistribution and
recovery depends mostly on metabolism (a slow process)
b. If a drug has high lipid solubility, it is readily redistributed from the blood
to the muscle and fat tissues, where it is not available to act on the brain.
Therefore, recovery from a highly lipid-soluble drug is much faster
c. As the blood levels decline because of metabolism, small quantities of the
redistributed drug (from muscle and fat) reenter the circulatory system to
also be metabolized
d. The low levels that arise from the muscle and fat stores are not sufficient to
clinically alter the level of consciousness
4. Barbiturates are eliminated from the body through liver metabolism, and their
metabolites are excreted into the urine
IV. Examples of barbiturates
A. Pentobarbital
1. Once used commonly for anesthetic inductions, it now has been replaced mostly by
the ultrashort-acting barbiturates
2. It can also be used to control seizures (although electroencephalographic seizure
activity may persist)
3. It can be administered IM for sedation without tissue reaction
4. With intravenous induction, there is a significant effect at 1 minute after injection
(maximum effect is in 5 minutes)
5. Recovery by metabolism is slow and rough in all animals except sheep (recovery is
smoother and faster)
B. Thiopental
1. Available as a crystalline powder in multidose vials that can be reconstituted into
various concentrations
2. Limited stability once reconstituted
3. Avoid injecting air that may cause premature precipitation
4. Has a high lipid solubility
5. Enters the brain rapidly
6. Redistribution from the brain to other tissues; therefore, initial recovery is fairly
quick
a. It is redistributed to muscle and fat tissue and metabolized very slowly
7. Avoid in sight hounds; low body fat will result in a prolonged recovery
8. Problems with recovery will occur if subsequent doses have been given for
maintenance of anesthesia and if the muscle and fat tissues are saturated
a. Cumulative effect with repeated administration
b. Recovery will be slow and rough
c. Best to use for induction only or a maximum maintenance of 30 minutes
9. Significant effect is noted 30 to 60 seconds after injection
10. There is a transient arrhythmogenic potential with this drug, especially if given
rapidly
a. Transient apnea may occur if given rapidly
11. If given perivascularly at a concentration of greater than 2.5% (25 mg/mL), it can
cause extreme tissue irritation and may lead to tissue sloughing
a. If this accidentally occurs, DILUTE the perivascular thiopental by injecting
small amounts of normal saline around the site
12. Poor relaxation and analgesia when used alone
C. Methohexital
1. Highly lipid soluble and rapidly metabolized
2. It has the quickest onset, shortest duration, and quickest recovery (even if used for
long-term maintenance)
3. Good choice of barbiturate for sight hounds or other patients with excessively lean
body
a. These patients seem to be extremely sensitive to barbiturates (because of
poor ability to metabolize and a lack of fat storage), and they have prolonged
recoveries
b. Liver metabolism of methohexital is more rapid; therefore, additional
administration is not cumulative
4. Good choice for brachycephalics to obtain quick and smooth intubation and rapid
recoveries without hangover effects
 a. Induction effect is noted 15 to 60 seconds after injection
5. Induction and/or recovery may be rough and accompanied by seizures. This effect
can be minimized if the patient is given good sedation
6. Lethal dose is only 2 to 3 times the anesthetic dose
7. Methohexital can cause profound respiratory depression
8. No longer available in Canada

Nonbarbiturate Anesthetic Drugs

I. Examples of nonbarbiturate anesthetic drugs include propofol, alfaxalone, etomidate, fentanyl,
guaifenesin, and chloral hydrate
A. Propofol
1. CNS depression by binding to specific GABA receptors in the brain
A

2. Short-acting hypnotic and alkylphenol derivative

3. Versatile: used for sedation, induction, and/or anesthesia maintenance by repeated
bolus injections or CRI
4. Rapid acting with smooth, excitement-free induction
5. Rapid smooth recovery, because of rapid metabolism due to redistribution to vessel-
rich areas such as the brain, rather than to muscle or fat
6. More easily and rapidly biotransformed by the liver than barbiturates; therefore, it
has reduced or possibly no hangover effect
7. First choice for inductions in sight hounds and other lean-body patients
8. Ideal for injectable maintenance of anesthesia, because there is no accumulation
9. Minimal cardiovascular effects, but may cause tachycardia, bradycardia, transient
arterial and venous dilation, and depressed cardiac contractility; therefore, use with
caution on most cardiac patients
10. Good anticonvulsant
11. Nonirritating with incidental perivascular injection
12. Muscle relaxation
13. Analgesia is poor
14. Will support bacterial growth because of soy content (no preservative). Opened vials
should be discarded within 6 hours to avoid contamination
15. Contraindications and cautions
a. Respiratory depression (dose related)
(1) Transient apnea has been reported after rapid intravenous injection
(2) Apnea is very dependent on how quickly the drug is given, and it
has caused respiratory arrest in some cases
b. Avoid in animals that are hypotensive (e.g., blood loss, dehydration, recent
trauma, or severe illness)
c. May see transient excitement and muscle tremors
d. Crosses placental barrier
B. Alfaxalone
1. Neuroactive steroid molecule with properties of a general anesthetic
2. Binds to GABA -specific receptor sites to produce CNS depression
A

3. Newest anesthesia drug for dog and cat use only

4. Historically, this drug was first introduced (1970) as alfadone (e.g., Safan). This
formulation was removed from the market due to its many side effects
5. No antimicrobial preservative; therefore, any unused portions should be discarded
or refrigerated
6. No analgesia
 7. Used as an intravenous induction drug prior to inhalation anesthesia, as
maintenance anesthesia (e.g., minor procedures and diagnostics up to 1 hour), or as a
CRI
8. Transient induction apnea can occur after initial intravenous dose if given rapidly
(give slowly over approximately 60 seconds)
9. Respiratory depression may occur (dose dependent)
10. Little or no cardiovascular effects at normal doses
11. Can be used in combination with any of the preanesthetic drugs (e.g.,
phenothiazines, anticholinergics, benzodiazepines, -agonists, opiates); however,
2

the drug type and dose are based on the patients preanesthetic assessment and
evaluation
12. Alfaxalone dose is reduced with some preanesthetic drugs (e.g., premedication with
-agonists)
2

13. The alfaxalone depressant effect may be potentiated when other CNS depressants are
used
14. Cannot be used in combination with other intravenous anesthetic drugs, nor should
it be mixed with veterinary medicinal products
15. Excitement and/or minor muscle twitching may occur
16. Safety of this product has not been established in pregnancy or during lactation or
with regard to effects upon fertility
C. Fentanyl
1. Considered primarily an analgesic
2. It can produce unconsciousness
3. Used as an injectable induction agent, often in combination with a tranquilizer,
sedative, or benzodiazepine
4. Referred to as a neuroleptanalgesic
5. It is safe for high-risk patients, because it does not cause apnea and does not affect
contractility or cardiac output
D. Etomidate (imidazole derivative)
1. Very safe, ultrashort-acting, rapidly distributing, noncumulative, nonbarbiturate
induction agent
2. Interacts with GABA receptors (as with barbiturates) to produce CNS depression
A

3. Very popular for animals with cardiac disease because it has little to no effect on
cardiac output, respiratory rate, and blood pressure
4. No analgesic properties
5. Can be given as repeated bolus or continuous infusion
6. Occasionally may cause vomiting, diarrhea, nausea, excitement, and apnea on
induction and recovery. Can be inhibited with proper preanesthetic medication
7. Mild respiratory depressant
8. Does not produce a histamine release
9. Produces excessive muscle rigidity and seizures in horses and cattle
10. Rapidly metabolized in the liver
11. Depression in adrenal function in dogs for 2 to 3 hours
12. Does cross placental barrier, but effects are minimal because of rapid clearance
13. Injection may be painful and may cause phlebitis, especially in the smaller veins
E. Guaifenesin (glycerol guaiacolate)
1. Blocks neural transmission of spinal cord and brain to produce total intravenous
anesthesia and facilitate intubation
2. Available as a powder and reconstituted with warm sterile water or dextrose
 3. To produce intravenous anesthesia and/or facilitate intubation, it is usually
administered with either thiopental or pentobarbital
4. This is a common decongestant and antitussive, and is commonly used for its effect
as a central muscle relaxant, mostly in large animals
5. Minimal effects on the diaphragm at relaxant dosages
6. Induction and recovery are excitement free
7. Minimal respiratory and cardiac effect
8. Does cross placental barrier, but effects on fetus are minimal
9. Excessive doses may cause apneustic breathing and muscle rigidity

Dissociative Anesthetics
I. Cyclohexamines are classified as dissociative anesthetics, which are drugs that interrupt neural
transmissions that induce unconscious and conscious brain functions (e.g., dissociation from ones
environment)
II. Examples of dissociative anesthetic drugs include ketamine HCl (Ketalar, Ketaset, Vetalar),
phencyclidine, and tiletamine HCl (Telazol)
III. Indications and side effects
A. Produce a cataleptic state through CNS excitement (not through depression)
B. Inhibit N-methyl-D-aspartate (NMDA), resulting in analgesia, catalepsy, and poor muscle
relaxation
C. Analgesic properties: selective superficial analgesia
D. Visceral pain not abolished
E. Pharyngolaryngeal reflexes are partially intact
F. Produce cardiovascular stimulation (increased blood pressure, decreased cardiac
contractility, and increased heart rate)
G. Increase muscular rigidity, which can be minimized by prior administration of tranquilizers,
sedatives, or benzodiazepines
H. Apneustic breathing pattern (slow, deep inspirations characterized with a pause before a
brief exhalation)
I. Respiratory rate may increase (decrease in arterial CO , especially after administration)
2

J. Hyperresponsive and ataxic during recovery

K. Small percentage of cats will show convulsive behavior, especially with large doses
L. Minimally sensitize the heart to catecholamine-induced arrhythmias
M. Tissue irritation
N. Increased salivation and lacrimation
O. Increase in intracranial pressure
P. Immobilization of patient
Q. Amnesic properties (loss of memory)
R. Open eyes with central dilated pupils
S. Nystagmus (repetitive side-to-side motion of the eyeball)
T. Increase in intraocular pressure
U. Temporary personality changes
V. Excitement on recovery
W. Can administer via mouth (mucous membrane absorption is effective in aggressive cats)
X. Effects partially reversed by adrenergic and cholinergic blockade
Y. Metabolized by the liver and excreted somewhat in an unchanged form through the kidneys
in dogs
Z. Excreted primarily by the kidneys in the cat
 AA. Can be used in cats with urethral obstruction, provided that renal disease is absent and the
obstruction has been eliminated
BB. No antagonists for this class of drugs
CC. Use of ketamine alone or as adjunct with opioids, -agonists, phenothiazines, and
2

benzodiazepines
DD. For use in small animals, large animals, exotics, and wild animals
IV. Contraindications
A. May induce pulmonary edema or acute heart failure in animals with preexisting heart
conditions
B. Use with caution in animals with hepatic or renal disease
C. Never use alone in cats (increased muscle rigidity)
D. Used alone in dogs, may cause seizurelike activity; therefore, ketamine should be combined
with a tranquilizer (e.g., acepromazine or diazepam) when used in dogs
E. Avoid as a preanesthetic medication in dogs
F. Avoid in animals with seizure history (may cause seizures with high doses)
G. Provide poor visceral analgesia but fair to good peripheral analgesia
H. Increase intracranial pressure: do not use in neurological cases (e.g., possibility of brain
herniation or tumor) or if you suspect increased intracranial pressure (e.g., head trauma in
patient that was hit by car)
I. Increase intraocular pressure; therefore, do not use if there is a suspicion of glaucoma or
perforation of the eye chamber
J. Prolonged and unreliable recovery
V. Ketamine
A. Provides somatic analgesia
B. Commonly combined with diazepam or other benzodiazepines as an induction agent
1. This provides muscle relaxation and smoother recoveries than with ketamine alone
C. In species in which intravenous administration is not possible or easily accessible, ketamine
can be combined with midazolam and given IM
VI. Tiletamine
A. Tiletamine and zolazepam are combined commercially in Telazol for use in all animal
species
B. Same action as ketamine/diazepam but can be given IM or SC; therefore, it is good for exotic,
wild, and aggressive animals

INHALATION ANESTHETIC AGENTS

I. Definition of anesthesia or anesthesia state: unconscious, immobile (lack of autonomic response) to
noxious stimuli (actual or potential tissue damage that causes pain), state of analgesia, and amnesia
II. General considerations
A. Inhalant anesthetics are used to produce general anesthesia and are suitable in all species
B. Inhalant anesthetics affect many receptors (e.g., GAGA , glycine, acetylcholine, serotonin)
A

C. They are vapors or gases that are directly absorbed into the system through the lungs
D. Are absorbed from the alveoli into the bloodstream and carried to the brain relatively
rapidly
E. Primarily eliminated unchanged by the lungs
1. Biotransformation of inhalation anesthetics to metabolites does occur to some degree
F. Metabolism is generally by hepatic microsomal enzymes
III. Factors affecting the concentrations of the inhalant anesthetics include vapor pressure, boiling point,
anesthetic system, ventilation, and solubility
 A. Vapor pressure is the measure of the volatility of the anesthetic liquid. The liquid form
requires a carrier gas, correct temperature, and correct vaporizing chamber to be able to
convert the liquid form into a vapor phase so that it can be safely administered through a
breathing system
B. Boiling point of a volatile liquid is the temperature at which the vapor pressure equals the
atmospheric pressure (760 mm Hg). All modern vaporizers are temperature compensated
(80.6 F [27 C])
C. Anesthetic system includes type of anesthetic circuit, rate of fresh gas flow, vaporizer
(specific to the inhalant agent), and requires diligent inspection of equipment prior to
anesthetizing a patient (e.g., inspecting for leaks)
D. Ventilation is a major factor that facilitates the uptake of the inhalant agent from the lungs.
This is accomplished by inspiring a specific concentration (gradient between the inhalant
partial pressure and the alveolar partial pressure)
E. The uptake depends on the concentration (vaporizer setting) and the volume (tidal volume)
F. Factors affecting ventilation (inspired and alveolar): vaporizer setting, respiratory rate, tidal
volume, dead space (anatomic and physiological), and patent airway
G. Uptake from the lungs into the bloodstream is determined by the solubility of the inhalant,
which is measured as a partition coefficient (PC)
1. Solubility of inhalant agents in the blood and body tissues is the major factor in the
uptake rate and their distribution in the body
2. The PC is a ratio of the amount of anesthetic in the blood to the amount of the same
volume of the gas in contact with the blood (e.g., blood and gas) or between two tissue
solvents (e.g., brain and blood)
3. The blood/gas PC (Ostwalds coefficient) is most important in describing and
measuring inhalant anesthetics. It will provide speed of the induction, change in
anesthetic depth, and recovery time
a. Inhalant anesthetics with a relatively high blood/gas PC will have a slower
onset and longer time to produce anesthesia. They will also have a slower
recovery time
b. Inhalant anesthetics that have a lower blood/gas PC (e.g., sevoflurane) will
have faster induction and recovery periods
IV. Potency of inhalant anesthetic agents
A. Expressed as the minimum alveolar concentration (MAC) of the drug that produces no
response in 50% of patients exposed to a painful stimulus
B. The lower the MAC, the more potent the anesthetic. A lower concentration is thus required to
maintain a similar anesthetic depth
C. Values vary among species and are affected by age, temperature, disease, other CNS-
depressant drugs, and pregnancy
D. The more lipid soluble an inhalant is, the more potent it is
E. Table 21-3 presents a summary of the properties of selected inhalant anesthetic agents

TABLE 21-3
Properties of Inhalation Anesthetic Agents
 Isoflurane Sevoflurane Desflurane

Trade name Forane, AErrane SevoFlo, Sevorane Suprane

Vapor pressure (mm Hg) at 68 F (20 C) 252 160 664

Boiling point ( F [ C]) 118.4 (48) 138.2 (59) 73.8 (23.5)

Minimum alveolar concentration (MAC) in dogs (%) 1.2 2.1 7.2

Blood/gas partition coefficient 1.4 0.65 0.45

Rate of metabolism (%) 0.25 3.0-5.0 0.02

V. Elimination of inhalant anesthetic agents
A. Excreted mostly by the lungs
B. The rate of elimination by the lungs depends on the blood flow, pulmonary ventilation, and
solubility of the inhalant anesthetic agent
C. All inhalants undergo variable degrees (e.g., isoflurane < 0.2%; sevoflurane, 3%) of
biotransformation in the liver (lesser degree in the kidneys, intestinal tract, and lungs), by
which the gases are metabolized into toxic metabolites
VI. Advantages over injectable anesthesia
A. Easier to control and change depths of anesthesia
B. Excreted mainly by respiration; therefore, recovery is fairly rapid and there is little
metabolism
C. Require administration of oxygen (O ) to the patient, which provides a patent airway
2

(endotracheal tube placement)

D. Respiratory and cardiovascular depression is minimal at safe concentrations
E. Provide some analgesia and muscle relaxation
F. Minimal side effects
G. Less accumulation and recoveries are rapid
H. Based on the patients preassessment, the combination of premedication, intravenous
induction drugs, analgesia (e.g., injectable, CRI, local blocks), and inhalant anesthesia will
provide a balanced, safe anesthesia protocol
I. Combining adjuncts will also decrease the amount of inhalant anesthetic required
J. Nonexplosive
K. Inexpensive
L. Inhalant anesthetic agents must interact with carbon dioxide (CO ) absorbents (e.g., soda
2

lime, barium hydroxide lime) in CO canisters. This results in production of toxic metabolites
2

and heat
 1. Both isoflurane and desflurane contain a difluoromethoxy moiety (CHF ) that reacts
2

to the CO absorbents and produces carbon monoxide (and heat)

2

2. Sevoflurane will react to CO absorbents (e.g., barium hydroxide lime) and degrade
2

into compound A and haloalkenes, which are very nephrotoxic

CLASSIFICATIONS OF INHALANT DRUGS

Isoflurane
I. Physical and chemical properties
A. Halogenated ether
B. Volatile and potent anesthetic agent
C. Chemically similar to sevoflurane
D. High vapor pressure (easily vaporized); therefore, precision out-of-circle vaporizers (VOCs)
used
E. Least soluble of volatile inhalant anesthetics in blood, tissues, and anesthetic components
F. MAC: 1.2% in dogs and 1.6% in cats
G. Very stable compound; no preservative required
H. Does not react to metals
I. Less expensive than sevoflurane and desflurane
II. Pharmacological effects
A. CNS depressant
B. Low solubility in the tissues: rapid changes in anesthetic depth
C. Low solubility: rapid induction and recovery times
D. Minimal to moderate effects on the cardiovascular system: reduced arrhythmogenicity and
better cardiac output (dose related)
E. Does not sensitize the heart to catecholamine-induced arrhythmias
F. Vasodilation and hypotension, which are dose related
G. Muscle relaxation
H. No renal changes
I. No hepatotoxicity
J. Minimal hepatic metabolism
K. Gastrointestinal: decreased muscle tone and motility
L. Faster recoveries could result in occasional stormy recoveries
M. Alveoli absorption and elimination of the agent and primarily excreted unchanged in the
lungs
N. Little biotransformation (0.25% is metabolized to trifluoroacetic acid)
O. Can trigger malignant hyperthermia in pigs
P. Crosses placental barrier rapidly
Q. Can be used for all species

Sevoflurane
I. Physical and chemical properties
A. Halogenated ether that is nonflammable and nonexplosive
B. Low blood/gas PC
C. Blood solubility is similar to desflurane: rapid induction and recovery times
D. Nonpungent and nonirritating odor; therefore, mask or chamber inductions are easier
E. MAC: 2.4% in dogs and 2.6% in cats
 F. When in contact with certain CO absorbents (e.g., Baralyme or soda lime) within anesthesia
2

machines, sevoflurane can undergo two degradation pathways that produce and generate
compound A (first pathway), formic acid, and carbon monoxide (second pathway) degradants
G. The degradation process and degradant formation (of both pathways) is enhanced by a high
percentage of sevoflurane concentration, low fresh gas flows, increased temperatures, and
desiccated CO absorbents
2

H. Compound A is nephrotoxic
I. If there is a continual formation of high temperatures, further dehydration of Baralyme, and
carbon monoxide production, possible explosion and fire could occur
J. Does not require a preservative
K. High vapor pressure, therefore highly volatile agent; used only in agent-specific precision
vaporizers (e.g., VOCs)
II. Pharmacological effects
A. Rapid anesthetic depth is achieved because of its low solubility in the blood (similar to
isoflurane)
B. Produces dose-dependent CNS depression
C. Low solubility, and therefore extremely rapid induction and recovery (faster than isoflurane)
D. Low solubility; rapid changes in anesthetic depth can be achieved
E. Produces analgesia and muscle relaxation
F. Dose-dependent cardiovascular effects: decreased cardiac output and blood pressure
G. Nonarrhythmogenic (does not sensitize the myocardium to catecholamine)
H. Cardiac depression (dose dependent)
I. Respiratory depression similar to that of isoflurane
J. Crosses placenta rapidly and will cause fetal depression
K. Much more expensive than isoflurane
L. Excellent choice of inhalant for avian species because of its smooth rapid induction and
recovery phases, which minimizes stress on these patients
M. Slight hangover that is present with other inhalants is lessened or absent with sevoflurane
N. Excretion of sevoflurane is mostly through exhalation
O. Approximately 3% of sevoflurane is metabolized and produces metabolites (similar to
isoflurane)

Desflurane
I. Physical and chemical properties
A. Halogenated ether
B. Similar to isoflurane in structure; however, it has fluorine instead of chlorine
C. At commonly used concentrations, it is nonflammable and nonexplosive
D. Extremely low solubility; very rapid inductions and recoveries. It is the most rapid acting of
all inhalation agents; lower blood/gas PC
E. Less potent than other agents
F. Pungent and produces airway irritation, which provokes coughing and breath holding;
therefore, mask induction is very difficult
G. MAC: 7.2% in dogs and 9.79% in cats
H. Stable compound; therefore, does not require a preservative
I. Does not react to metals
J. Low boiling point; therefore, temperature greatly influences the vapor pressure. It requires an
electrically heated vaporizer, which is very expensive
K. Expensive
II. Pharmacological effects
 A. CNS depression is dose related
B. Good muscle relaxation and analgesia
C. No hepatotoxicity or nephrotoxicity
D. Dose-related depression of cardiovascular system. Effects are similar to those of isoflurane
E. Nonarrhythmogenic (does not sensitize the myocardium to catecholamine)
F. Dose-related respiratory depression
G. Gastrointestinal: decreases muscle tone and motility
H. Excretion primarily through exhalation; however, 0.02% of inhalant is metabolized (e.g.,
metabolite is fluorine)
I. Can cause malignant hyperthermia in some species
J. Crosses placental barrier and can cause fetal depression
K. Recovery may be too rapid and/or unpleasant, which may require additional sedation

ANESTHETIC EQUIPMENT
Materials Required for Induction of Anesthesia
I. Preanesthetic agents
II. Induction anesthetic agent
A. Intravenous catheter placement may take place prior to induction of anesthesia for fluid
therapy or intravenous access
III. Adhesive tape if venous access will be required or the anesthetist intends to top up the anesthetic
level
IV. Tourniquetif required
V. Clippers (surgical blade no. 40)
VI. Alcohol (70% isopropyl) for vein preparation
VII. Mouth gag or speculum and appropriate-size laryngoscope or light source
VIII. Sterile lubricant
IX. Rolled gauze or shoelace to tie the endotracheal (ET) tube around muzzle or behind ears of small
dog or cat
X. A 6- or 12-mL syringe to inflate the cuff of the ET tube
XI. Endotracheal tubes (three of various sizes should be ready for use) (Table 21-4)
A. Most cats require a 3.0- to 4.5-mm tube
B. The appropriate size for a dog is dependent on its size and weight
1. The body conformation, breed, and level of obesity can change the required size of
ET tube
C. The length of the ET tube is generally standard
1. It should extend from the tip of the nose to the thoracic inlet
2. If the tube is too long, it may enter the main stem of the bronchus and therefore
supply anesthetic to only one lung field
3. If the tube is too short, it may not reach the trachea
4. Either situation could result in hypoxia and hypoventilation
D. Preparation of the ET tube
1. Make sure the tube is clean and free of debris and damage (bite marks)
2. Inflate the cuff and leave it inflated for a few minutes to ensure it is staying inflated
3. Lubricate the tube while the cuff is inflated to ensure that the entire cuff is lubricated
E. Canine intubation
1. Canine patients can be placed in sternal, dorsal, lateral, or dorsal oblique position
2. If a restrainer is available, have the restrainer hold the head by placing one hand on
the maxilla and the other at the neck region
 3. Using a laryngoscope or other light source, visualize the epiglottis by pulling the
tongue forward. The glottis and vocal chords will also be evident
4. By using a gentle twisting motion, insert the lubricated ET tube into the trachea
5. Tie the tube in place either over the muzzle or behind the ears
6. Tube placement can be checked by observing condensation in the tube, palpating the
neck area for the tube, auscultation of lung sounds while bagging the animal, CO 2

reading on a capnometer, or observing air movement by placing a small amount of

hair or a rolled bandage tie at the end of the tube
7. Inflate the cuff
a. The cuff should have been checked previously before placing the ET tube in
the trachea
8. Attach the breathing circuit to the ET tube and turn on the flowmeter and anesthetic
vaporizer at the appropriate levels for the patient
9. Check for leaks by applying positive pressure to the reservoir bag, observing the
manometer, and listening for leakage of gas around the ET tube
10. Add small amounts of air to the cuff if needed to prevent leakage
11. Assess the patient and continue monitoring procedures
F. Feline intubation
1. Feline patients can be placed in sternal or lateral position
2. Feline patients require the use of 2% lidocaine (xylocaine) gel or spray to anesthetize
the glottis prior to intubation
a. Cats and rabbits are prone to layrngospasms during intubation
b. 2% Lidocaine should be used sparingly since it can induce a toxic reaction
3. Since feline ET tubes are very small, they may require a stylet for easier handling of
the tube
4. After lubricating the tube, check to see that there is no lubricant occluding the end of
the tube
5. The ET tube can be inserted in the trachea, and then secured by a tie placed around
the head and ears to prevent movement of the tube
6. Feline patients do not always require the cuff to be inflated
a. If the patient is undergoing a dental procedure, a cuffed ET tube should be
used
G. Extubation
1. After the required procedure has been completed, turn off the anesthetic vaporizer
and continue to monitor the patient
2. Flush the system of anesthetic by removing the Y connector, occluding the tube, and
flushing the system using the flush valve
3. Allow the patient to breathe only O for 5 to 10 minutes
2

4. After 10 minutes, the flowmeter can be turned to 0 and the patient can be
disconnected from the breathing circuit
5. The patient can be stimulated to return to consciousness by rubbing the body,
moving the legs, gently moving the head and neck, and rolling the patient
6. When the patients gag reflex returns or the patient is swallowing, the ET tube
cuff can be deflated and the ET tube can be quickly removed from the trachea
7. If conscious, the patient can be removed to a recovery area and monitored
8. Monitoring should include checking of any incision for hemorrhage, mucous
membrane color, heart rate, respiratory rate, and temperature
9. Hyperthermic devices can be used to increase the patients body temperature
 a. Heating pads are not a good source of heat for semi-unconscious animals
since they may not be able to move off a hot pad
b. Heated pucks and oat bags can also be too hot for the recovery patient
c. Blankets, circulating hot water blankets, or hot air blankets are the best
sources of heat
10. Postoperative pain management medications can be administered as instructed

TABLE 21-4
Recommended Endotracheal Tube Sizes in Veterinary Anesthesia*

Species Body Weight (kg) Diameter of Endotracheal Tube (mm)

Feline < 1 3

1-3 3.5-4

3-5 4-4.5

Canine 1-2 5

2-4 6

5-8 6-7

9-12 6-8

13-17 7-9
Species Body Weight (kg) Diameter of Endotracheal Tube (mm)

18-21 8-10

22-25 9-11

> 25 10-12
*
This chart is a guide only. Breed, conformation, and obesity will affect the size of the endotracheal tube used in any individual
patient.

ANESTHETIC INDUCTION EQUIPMENT

I. Masks are used to supply O and also to induce anesthesia
2

A. Masks are generally made of plastic with a diaphragm attached to the mask
1. The diaphragm ensures the mask fits snuggly over the patients nose
B. Masks are purchased in various sizes
II. Chambers can only be for animals that are small enough to fit inside
A. Chambers can be used for small fractious animals
 B. They are made of Plexiglas with an outlet and inlet connection
C. The chamber requires high levels of O (5 L/min) and isoflurane (5%) or sevoflurane (8%)
2

D. Chambers are similar to large fish tanks

E. They can easily be cracked or broken by dropping
F. They use a large amount of gas for induction of anesthesia
G. Generally after induction the patient can be removed from the chamber, placed on a mask,
and then intubated
H. It is impossible to monitor patients in a chamber, although they are visible through the sides
of the chamber
I. Patients are often stressed and active, may vomit, and possibly have an airway obstruction
during a chamber induction

Anesthesia Machine
I. Inhalant anesthetic agents are delivered to the patient through the respiratory system. The inhalant
agents are liquids that are vaporized and delivered with a carrier gas into the breathing system and
ultimately to the patient
II. The anesthesia machine is designed to safely and accurately deliver inhalant agents at a controlled
concentration and rate (with the use of a vaporizer specific to the agent)
III. The anesthesia machine also eliminates exhaled and waste gases from the patient and environment,
thereby reducing pollution

Components of an Anesthesia Machine

Each component of the anesthesia machine is numbered on Figure 21-1, A. These numbers correspond to the
roman numerals in the following description of the components and their function.
FIGURE 21-1, A Components of an anesthesia machine (Roman numerals indicate corresponding description in this section
of the text).
1. Gas supply (I)

2. Check valve (II)

3. Pressure gauge (III)

4. Pressure-reducing valve or regulator (IV)

5. Flowmeter (V)

6. Vaporizers (VI)

7. Circle system (VII)

8. Unidirectional valves (VIII)

9. Reservoir bag (IX); location only, no bag shown

10. Pop-off valve/pressure relief valve (X)

11. Carbon dioxide absorber (XI)

12. Common gas outlet (XII)

13. Oxygen flush valve (XIII)

14. Bain mount (XIV); mount shown, no Bain system

15. Pressure manometer (XV)

16. Scavenging system (XVI)

(Courtesy D. Dyson, DVM, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.)
I. Gas supply (Figure 21-1, A, no. 1)
A. On the anesthesia machine, there may be more than one O source. Figure 21-1, A, (no. 1)2

shows an example of two sources of O (E cylinder and O line) 2 2

B. Gas supply consists of compressed medical gas cylinders and/or central gas supply (bulk
sources) of medical gases, which can supply O 2

C. Workplace Hazardous Material Information System (WHMIS) (Canada) classifies

compressed gas cylinders into US OSHA Hazardous Class 2 as well as subclasses to indicate
that there are flammable and combustible hazards
D. Compressed gas cylinders are strictly regulated and therefore require labels that are color
coded, displaying the name of the gas, hazards associated with the content, and the name and
address of the manufacturer and distributor
E. Cylinders also require a material safety data sheet (MSDS), which outlines potential hazards
such as health, environmental, reactivity, and fire. These are sheets that are to be used by
personnel working with or around the cylinders
F. Cylinders: made of steel, a steel alloy, or aluminum, and are pressurized
G. Cylinders come in a range of different sizes dependent on the properties of the gas as well as
the manufacturer or distributor
H. All cylinders, regardless of their size, must be handled carefully and stored properly as per
the guidelines specified by the manufacturer/distributor and MSDS
I. Training in the use and handling of compressed gases can be set up with your local
distributor
J. Oxygen is contained in compressed gas metal cylinders
1. They are found as E-size cylinders that are usually attached to the machine (portable
sources of medical gases) via hanger yokes that are equipped with a specific pin index
system (Figure 21-1, B)
FIGURE 21-1, B The cylinder assembly. The assembly consists of the hanger yoke, E-size oxygen cylinder, and a pin index
system for the cylinder (red arrows) that is specific to each compressed gas cylinder; therefore, a different size or type of gas
cannot be connected.
2. Primarily used for transporting anesthetized patient and for emergencies (e.g., if
central or bulk supply fails)
3. Cylinders also come in larger sizes, which can be attached to a manifold to provide
an economical way of supplying medical gases to the anesthesia machine
4. Central gas supply (bulk) and bank sources of medical gases require a pipeline
system, which delivers the gas to stations within the hospital/clinic. The stations are
color coded and fitted with noninterchangeable, gas-specific connectors (e.g.,
diameter-indexed safety system [DISS])
5. DISS connectors are specific to each gas (i.e., cannot connect an O line into a nitrous
2

oxide [N O] connector or vice versa)

2
 6. Sources of bulk O (central) include cylinders of liquid O , or bank of compressed gas
2 2

cylinders (e.g., G, H, K, M, T sizes)

7. The size of cylinder(s) required for central gas supply will depend on the
requirements of the hospital/clinic
8. Depending on the manufacturer/distributor, the cylinders are filled and pressurized;
however, the volume of a cylinder can be calculated by multiplying the available
cylinder pressure (in pounds per square inch) by a conversion factor
II. Check valve (Figure 21-1, A, no. 2)
A. Situated in the E-tank yoke of the anesthesia machine, in the pipeline (to and from the bulk
source), and in the regulators
B. Ensures a one-way flow of gas from the tank, regulator, or pipeline. Therefore, when you
disconnect the O line from the bulk system while the E tank is on, O will not come out of the
2 2

O line
2

C. Also, if the machine is connected to the bulk system when the E tank is disconnected and
removed, the O cannot come out of the yoke
2

III. Pressure gauge (Figure 21-1, A, no. 3) for cylinder

A. It is attached to hanger yoke of the anesthesia machine, which has the cylinder attachment
B. Indicates the cylinder pressure when the valve on the tank is open
C. Gauges are labeled and color coded with their specific gas symbol
D. The pressure in a full O E cylinder is approximately 2200 pounds per square inch (psi), or
2

15,000 kilopascals (kPa)

1. Oxygen tanks should be changed when the pressure drops below 100 psi (680
drops below 100 psi (680 kPa)
2. The volume of an O E tank can be calculated by multiplying the psi by 0.3
2

3. A full tank of 2200 psi will contain 660 L of O (2200 0.3 = 660 L)
2

IV. Pressure-reducing valve or regulator (Figure 21-1, A, no. 4)

A. Pressures in the cylinders are high and therefore must be reduced and regulated to provide a
safe, constant pressure and flow of gas to the flowmeter
B. Reduces the high pressure of the O leaving the tank to a low pressure of approximately
2

50 psi (340 kPa)

C. Can also have portable regulators that attach to larger cylinders directly (known as staged
regulators)
V. Flowmeters (Figure 21-1, A, no. 5)
A. Measure and indicate the rate of gas flow to the common gas outlet
B. Measure O in liters per minute (L/min)
2

C. Allow the anesthetist to set the O flow rate that will be delivered to the patient
2

D. As the gases pass through the flowmeter, gas pressure is reduced further from 50 psi (340
kPa) to 15 psi (100 kPa)
E. Newer machines have improved accuracy because of flowmeter designs that can deliver
lower flows of O (< 1 L/min) and higher flows of O (> 5 L/min)
2 2

F. Ensure appropriate amount of O delivered to meet the patients metabolic demands and
2

ensure sufficient O concentration for proper hemoglobin saturation

2

VI. Vaporizers (Figure 21-1, A, no. 6)

A. Vapor pressure is characterized by the amount of vapor relative to its liquid volume in a
closed container. The pressure exerted by the gas is called the vapor pressure and will
increase with temperature. Because most anesthetics vaporize at a concentration higher than
necessary for clinical anesthesia, a vaporizer is used to deliver diluted anesthetics to patients
B. Convert the liquid anesthetic into a gas state and control the amount of vaporized anesthetic
sent to the carrier gases
 C. Agent specific
D. Most have an indicator window that shows amount of liquid anesthesia agent in the
vaporizer
E. If the anesthesia machine and/or vaporizer are tipped or shaken, the anesthesia liquid could
enter the bypass area of the vaporizer. This could increase the amount of anesthesia delivered
to the next patient
F. Maintenance and servicing are required to ensure that the vaporizer functions properly (e.g.,
the percentage dialed is accurate, there are no leaks)
G. For vaporizer maintenance, follow the manufacturers guidelines and recommendations
H. Vaporizers are categorized based on their location relative to the breathing system
1. VOC: vaporizer out-of-circle
a. The vaporizer sits outside the breathing circuit between the O flowmeter
2

and circle (refer to Figure 21-1, A)

2. Precision vaporizers
a. Gas flow, temperature, and backpressure are compensated
b. Graduated dial with percentage concentration (e.g., 1.5%, 2%)
c. Percentage dialed is the exact output amount of anesthetic agent
d. Percentage of anesthetic is determined by dial, chart, or mathematical
calculation
e. Are complex and expensive; however, they have the advantage of being able
to control the anesthetic agent closely
f. Not affected by changes in the flow rates or ventilation of the patient
VII. Circle system or breathing system (Figure 21-1, A, no. 7)
A. Figure 21-1, A, indicates where the breathing circuit is placed but does not show a circle
system or F-circuit; the circle system is shown in Figure 21-1, C
FIGURE 21-1, C The circle system and the individual components.
B. See Breathing Circuits section
C. Delivers the inhalant anesthetic(s), supplies the O , removes the CO , and provides a way to
2 2

assist or control the patients ventilation (e.g., reservoir bag)

VIII. Unidirectional valves (Figure 21-1, A, no. 8)
A. Also known as inhalation/exhalation flutter valves that are situated under dome covers
B. Ensure a unidirectional flow of gas to (inspiratory valve) and from (expiratory valve) the
patient when delivering anesthesia through a circle system (breathing system)
C. The valves move up and down; therefore, you must ensure that this function is working
during anesthesia to ensure proper gas flow
D. Can also be used to monitor the rate of breathing
IX. Reservoir bag (Figure 21-1, A, no. 9)
A. Also known as the rebreathing bag (Figure 21-1, A, shows location for both circle and Bain
system only and does not show the reservoir bag)
B. Is used to monitor spontaneous breathing
C. Allows the patient to breathe easier from a reservoir of gas
D. Allows for flexibility in the system
E. The reservoir bag can also be used to deliver O (with or without anesthetic gas) and
2

manually assist respirations, which is commonly called bagging or ventilating

F. The bag should hold 3 to 4 tidal volumes. (A tidal volume is 20 mL/kg of lean body weight)
1. Select a 0.5-L bag for patients up to 6 kg of body weight
2. Select a 1-L bag for patients between 6 and 16 kg body weight
3. Select a 2-L bag for patients between 16 and 35 kg body weight
4. Select a 3-L bag for patients over 35 kg
G. If the reservoir bag is too big for the patient
1. Manual positive pressure will be difficult
2. Monitoring the bag movement will be difficult since the change in the bag size will
be too small
3. It may take more time for the patient to respond to increased levels of anesthetic
H. If the reservoir bag is too small
1. It will increase the pressure in the circuit
2. It does not have a large enough volume for the patient to inspire comfortably
3. It will result in a dry bag or a continually deflated bag, which provides
minimal flexibility in the system
X. Pop-off valve (Figure 21-1, A, no. 10)
A. Also known as the exhaust valve or pressure relief valve (Figure 21-1, A, shows both circle
and Bain pop-off valves)
B. Exhaust gases leave the system via the exhaust valve and flow into the scavenging system
C. The valve can be fully or partially open when a patient is connected to the machine
D. The valve is closed for leak tests or when filling the reservoir bag for assisted respirations or
mechanical ventilation
XI. Carbon dioxide absorber (Figure 21-1, A, no. 11)
A. Used in the rebreathing systems to remove CO from the expired gases
2

1. Also known as the soda lime canister

2. Exhausted gases enter a canister containing soda lime or barium hydroxide
3. Na , K , Ca , or Ba hydroxide reacts with the exhaled CO and water to form
+ + 2 + 2 +
2

carbonate
4. Heat is liberated and the pH decreases
B. A pH color indicator turns blue or purple on consumption
 C. When the soda lime or barium hydroxide granules turn color or the granules become hard
instead of crumbly, they are saturated with CO and should be replaced
2

D. The canister should be filled up to 1 inch (2 cm) below the lid and contain at least two
thirds fresh granules
1. Personal protective equipment should be worn when filling canisters. Soda lime is
caustic and can cause damage to the upper respiratory tract.
E. When in use, granules will produce heat and condensation inside the canister
F. The color reaction is time limited, so exhausted crystals should be removed immediately and
replaced with new granules
1. Should be changed after 6 to 8 hours of use, depending on the size of the patient and
the gas flow rate
2. If the machines are left standing for longer than 30 days, granules should be replaced
before using the machine
3. New type of soda lime called Amsorb Plus
a. Made with two color indicators: white to violet or pink to white
b. Unlike conventional soda lime products, once exhausted it will not revert
back to the original color
G. New granules are soft and usually white in color
H. Used or spent granules are brittle, dry to touch, and purple or pink in color
XII. Common gas outlet (Figure 21-1, A, no. 12)
A. Where the mixture of anesthetic gases (including O ) exits the anesthesia machine through a
2

conduit tube (rubber or Silastic tubing) and enters into a breathing system (circle or Bain
circuit)
XIII. Oxygen flush valve (Figure 21-1, A, no. 13)
A. Oxygen bypasses the vaporizer, delivering 100% O to the breathing system
2

B. Enables the anesthetist to flush the system with pure O 2

C. Fills the reservoir bag and system to check for leaks (leak test the breathing system)
D. Also flushes anesthetic gases out of the circuit and replaces them with 100% O 2

E. Never use the O flush valve with the Bain system when it is attached to a small animal
2

1. It produces too much pressure, which could cause significant lung damage and
possible death
XIV. Bain mount (Bain system) (Figure 21-1, A, no. 14)
A. See Breathing Circuits section
B. Delivers the inhalant anesthetic(s), supplies the O , removes the CO , and provides a way to
2 2

assist or control the patients ventilation

C. Bain system (Figure 21-1, D) is fitted for
1. Coaxial (Bain) circuit
2. Fresh gas tube
3. Fresh gas outlet
4. Reservoir bag
5. Manometer
6. Pop-off valve
7. Scavenger tubing
8. Oxygen flush valve
FIGURE 21-1, D The Bain system and the individual components.
XV. Pressure manometer (Figure 21-1, A, no. 15)
A. Not to be confused with the tank pressure gauge
B. Sits on top of or near the CO absorber or on the Bain mount (Figure 21-1, D)
2

C. Measures the pressure in the circle or Bain system in millimeters of mercury (mm Hg) or
centimeters of water (cm H O) 2

D. Generally is calibrated from 30 to + 50 cm H O 2

E. Gauge reflects the pressure of gas in the animals airways and lungs
F. The pressure should be at zero with the patient spontaneously breathing
G. When providing positive assisted ventilation, the pressure should not exceed 15 to 20 cm
H O (11 to 15 mm Hg)
2

XVI. Scavenging systems (Figure 21-1, A, no. 16)

A. Minimize exposure of personnel, which could be a potential health hazard if they are
continually exposed to inhalant anesthetics
B. Attached to the exhaust valve (pop-off valve) of the circuit
C. A basic scavenging system consists of tubing that collects waste gases and directs them
outside of the building or to a charcoal canister that absorbs waste anesthetic gases
D. Scavenging systems can be active or passive
1. Active scavenging systems require a vacuum pump or fan to eliminate waste gases
from the anesthesia machine
2. Passive scavenging systems can vent gases by placing tubing through a hole in an
exterior wall of a building or attaching tubing onto an activated charcoal canister
a. There will be an increase in the canisters weight as the charcoal absorbs
the waste gases
b. Activated charcoal canisters must be weighed after each use and discarded
as needed
XVII. Negative pressure relief valve (not shown on Figure 21-1, A)
A. Some newer machines have this safety valve
B. If negative pressure is created in the system, the valve will open and allow room air into the
circuit
 C. Negative pressure could be caused by an active scavenging system (too high vacuum rate) or
low O supply
2

XVIII. Scavenger Interface (not shown on Figure 21-1, A)

A. Regulates air flow by adapting to changes in volume
B. Maintains balance between inflation flow and amount of unused gases
C. Has a negative and a positive pressure safety valve, thereby ensuring that there will not be
an overinflated or collapsed rebreathing bag
D. Should the main active scavenging system shut down, the Scavenger Interface is equipped
with a check-valve that will open (to the air) at a specific pressure, evacuate the gases, and
protect the anesthetized patient
E. Designed to be used with both circle and Bain systems, and therefore maintains a continuous
connection of all scavenger hoses, which means not having to disconnect from either system
F. Figure 21-1, E, shows three scavenger hoses (ventilator, Bain, and circle) coming out of the
Scavenger Interface
FIGURE 21-1, E The Scavenger Interface, a scavenging system that safely and efficiently scavenges waste gases from a Bain
system, circle system, and ventilator without having to change or disconnect scavenger hoses. (Courtesy Dispomed, Inc., Joliette,

Quebec, Canada.)
XIX. Circuit Alarm (not shown on Figure 21-1, A)
A. Safety device and alarm system that is attached to the anesthesia machine (Figure 21-1, F)

FIGURE 21-1, F The Circuit Alarm, which can be placed in the anesthesia machine. (Courtesy Dispomed, Inc., Joliette, Quebec, Canada.)

B. If circuit pressures (Bain or circle system) increase, (e.g., closed pop-off valve or kinked fresh
gas line), the Circuit Alarm will sound an alarm that pressure levels are higher than required
C. It is factory preset at 15 cm H O; however, it can be adjusted to allow pressure levels as
2

required

BREATHING SYSTEMS
Rebreathing System
I. Also called circle system
II. Rebreathing refers to breathing a mixture of expired gases and fresh gases
III. The amount of CO in inhaled gases depends on whether the breathing system has a CO absorber or
2 2

on the flow rate of fresh gases

A. The higher the fresh gas flow rate, the more expired gas is pushed out the scavenging system
and not rebreathed
IV. Depending on the flow rate of fresh gas, the system is classified as
A. Closed system (total rebreathing of expired gases)
B. Semiclosed system (partial rebreathing of expired gases)
V. Closed system: fresh gas flow rate does not exceed the patients metabolic O consumption, which
2

is 5 to 10 mL/kg/min
 A. The system may be used with a closed pop-off valve and a fresh gas flow of approximately 5
to 10 mL/kg/min
B. The expired gases are recirculated (after CO removal by absorber) with incoming fresh gases
2

C. There is a danger of increased CO accumulation if the CO absorber is not working efficiently

2 2

D. It is economical and there is minimal pollution

1. However, it takes longer to change planes of anesthesia
a. Oxygen depletion is common with this system
b. This system requires constant monitoring (should not leave patient
unattended) to ensure that pressures do not build up in the system if the O 2

flow delivered exceeds the metabolic requirement

E. It is recommended that the pop-off valve be left slightly open to prevent increased pressures
in the system and to adjust the O flow rate accordingly, to prevent the rebreathing bag from
2

collapsing
1. If the bag does not collapse, you can be confident you are delivering sufficient O to
2

meet the patients metabolic requirements

VI. Semiclosed system: also known as partial rebreathing system
A. The fresh gas is delivered in excess of the metabolic consumption at 25 to 50 mL/kg/min
B. The gas escapes through the pop-off valve to the scavenging system or after having the CO 2

removed by the soda lime, and then recirculates with fresh gases
C. Higher flows can be used

Nonrebreathing System
I. There is no mixing of inhaled and exhaled gases and no rebreathing of expired gases; all expired gas
goes to the scavenging system
II. CO absorber is not required
2

III. Fresh gas flow rates required at 130 to 300 mL/kg/min

IV. Induction and recovery O flow rates at 200 to 300 mL/kg/min
2

V. Maintenance O flow rate at 130 mL/kg/min

2

VI. At or below 130-mL/kg/min flow rate, there will be some rebreathing of exhaled gases

BREATHING CIRCUITS
I. There are many types of breathing circuits available. The most common in veterinary medicine are
circle systems (e.g., universal F-circuits) and Bain systems
II. Circle system (see Figure 21-1, C)
A. Consists of a CO absorber (e.g., soda lime canister) with inspiratory and expiratory
2

unidirectional valves, two breathing hoses connected with a Y piece to the patients ET
tube, a rebreathing bag, a pop-off valve (exhaust valve), and a scavenger hose
B. Can be used as a partial rebreathing system (25 to 50 mL/kg/min), or total rebreathing
system (5 to 10 mL/kg/min)
C. An advantage is the mixture of expired gases with incoming gases, humidifies and warms
the incoming gases
D. The main disadvantages of the circle system occur with smaller patients
1. Excess weight and bulk of hoses
2. Excess dead space (Y piece)
3. Resistance to breathing through unidirectional valves
III. Universal F-circuit
A. Basically a modified circle system where the inspiratory hose is placed within the expiratory
hose (coaxial design of tube)
 B. Still requires a CO absorber, rebreathing bag, unidirectional valves, pop-off valve, and
2

scavenger hose
C. Incoming fresh gas is warmed also by expired gases
D. The advantage is lighter weight and less bulk than the circle system (Y piece and circuit
hoses)
E. A disadvantage is that, if the circuit is stretched when in use, the end of the inspiratory hose
pulls away from the end of the expiratory hose. This is considered a safety feature to prevent
breakage of hoses, but it increases the amount of dead space
1. When not stretched, the dead space is less than that of the circle system
F. The Universal F-circuit can only be used with ET tube sizes less than 9.5
1. This is due to the size of the inspiratory tube within the expiratory tube
IV. Bain system (coaxial) (see Figure 21-1, D)
A. Consists of one tube inside another tube
B. Fresh gases flow through the inner tube, and the unused fresh gases and exhaled gases flow
through the outer tube
C. Bain circuit can be attached to a metal mount device, which consists of a reservoir bag, pop-
off valve, scavenger hose, and connection to the common gas outlet
D. Between breaths, the fresh gases flow through the inner tube toward the patient and then
back through the outer tube toward the scavenger hose
E. When the patient inspires, the gases are drawn from the inner tube, which will be 100% fresh
gases (O plus inhalant agent), or a mixture of fresh gases and expired gases (O plus inhalant
2 2

agent), depending on the fresh gas flow rate

F. This system can be used as a nonrebreathing system with fresh gas flow rates of 130 to
300 mL/kg/min
1. The high flow rates push exhaled gases away so that there is no rebreathing of
exhaled gases
G. This system can also be used as a partial rebreathing system with flow rates at or below
130 mL/kg/min
1. The flow rate pushes most of the exhaled gases away, but there is partial rebreathing
of some exhaled gases
H. The Bain system is ideal for small patients (< 10 kg) because of its light weight, minimal
dead space, and little resistance to breathing
1. The inspired gases are warmed by the expired gases
I. This system is good for small animals in general, but is not economical when patients weigh
more than 10 kg. Increased costs are associated with increased O flow rates
2

J. Limiting factor is the size of the patient

1. The O flowmeter must provide flow rates required for a partial or nonrebreathing
2

system
2. Total volume of the Bain hose must be greater than the tidal volume of respiration of
the patient to effectively prevent rebreathing
K. Good for procedures involving the head (less tubing in the way) or requiring much
manipulation (taking radiographs)
1. However, the universal F-circuits can be used now for larger patients for these
procedures
L. Warming and humidification are minimal with partial rebreathing
M. Requires a precision vaporizer

HEALTH HAZARDS AND ENVIRONMENTAL CONCERNS

I. Health hazards
A. Health hazards exist to personnel exposed to waste anesthesia gases. There are potential
toxic metabolites produced by the inhalant anesthetics biodegradation
B. Occupational Safety and Health Administration (OSHA) US and Canadian WHMIS
recommendation
1. Halogenated anesthetic agents (i.e., isoflurane, enflurane) should not exceed a dose
of 2 parts per million (ppm) per day
C. Reproductive problems
1. Studies show that, among personnel who work with waste gases (hospital setting:
OR nurses, doctors, anesthesiologists), there is a statistically significant increased risk
of spontaneous abortion among women
D. Other reported abnormalities
1. There have been reports of personnel with CNS dysfunction that results in
headaches, nausea, fatigue, and irritability
II. Environmental concerns
A. There are methods to reduce waste anesthetic gas exposure
1. Scavenging waste gases from the patient and anesthesia machine is probably the
single most important method
a. The different systems all have interfaces (scavenger tubing coming from the
anesthesia machine and attached to a disposal system) that can channel or
capture the waste gas
b. Scavenging/disposal systems, as previously mentioned, include active
(central vacuum) or passive (through the wall or charcoal absorbers) systems
c. Detection and correction of equipment leaks will decrease the amount of
waste anesthetic gas exposure
(1) See Equipment Maintenance and Concerns section below for
information on high-pressure versus low-pressure leaks
B. A certified biomedical technician performs preventive maintenance servicing on the
anesthesia machine and vaporizer. During this annual maintenance check, any major
equipment leaks or concerns can be addressed
C. Monitor the waste anesthesia gases in the environment by wearing a chemical exposure
monitor for the day. The badge is sent to a laboratory for analysis. Analysis will determine the
parts per million of anesthetic gas that the individual was exposed to in a specific time frame
(e.g., 8-hour workday)
D. Vigilant anesthesia techniques include:
1. Do not forget to attach the scavenger hose
2. Do not turn vaporizer on until the patient is connected to the delivery system
3. Use proper-sized cuffed ET tubes (uncuffed ET tubes in avian species, because they
have complete cartilage rings in contrast to dogs and cats)
4. Check ET tubes prior to intubation by inflating the cuffs and checking for any leaks
5. Empty the reservoir bag to the scavenger hose instead of into the room air
6. Minimal use of mask or chamber inductions
7. Avoid spilling of anesthetic agents; wear a specific respirator when filling or
emptying all vaporizers
8. Having a spill kit available, as well as a standard operating procedure in place, will
minimize hospital personnel exposure. Spill kits can be purchased at an
industrial/safety equipment company, or contact manufacturer for the MSDS that
outlines techniques to follow with inhalant anesthesia agents
 9. Everyone, especially pregnant women, should avoid exposure to waste anesthetic
gases, either by not being present or by wearing a specific respirator mask
10. Vaporizers and CO absorbers should be filled with minimal personnel in the room
2

and in a well-ventilated area; personnel should wear specific respirator mask and
gloves
11. In recovery, keep the patient on 100% O as long as possible and scavenge any expired
2

gases

EQUIPMENT MAINTENANCE AND CONCERNS

I. Before use, the machine should be checked for both high- and low-pressure leaks
A. High-pressure leaks
1. On a high-pressure system, check for leaks from the tanks or bulk gas supply to the
anesthetic flowmeter
2. Leaks can occur between the tank and flowmeter, DISS connectors on the central
lines, tank yoke connectors, regulators, manometers, and so on. These can be checked
by:
a. Turning on the tank, noting the tank pressure gauge reading, and turning
the tank off again. The flowmeter should be set at zero so that there is no line
evacuation of gas
b. In 1 hour, the tank pressure gauge should still have the same reading
c. Possible leaks can also be found by putting 10% detergent solution on any
tank connections or joints
(1) Bubble formation will indicate a leak
B. Low-pressure leaks
1. On a low-pressure system, check for leaks from the flowmeter of the anesthesia
machine to the patient
2. Leaks can occur at the connection between the flowmeter and vaporizer,
unidirectional valves, soda lime canister, ET tube, rebreathing bag, delivery hoses, and
pop-off valve. To check for low-pressure leaks
a. Turn the tank on (or connect to bulk system), close the pop-off valve, and
occlude the end of the hose so the gas cannot escape
b. Turn the flowmeter on, allowing the bag to fill gradually until there is
20 cm H O pressure (look at manometer) in breathing system
2

c. Turn flowmeter off

d. Maintain the pressure for a minimum of 10 seconds
e. If the pressure stays at 20 cm H O, there is no leak
2

(1) If the gauge on the manometer slowly falls (does not hold at
20 cm H O), there is a leak; therefore, look for leaks in all areas as
2

previously described
(2) Additional checks should be performed on the circuit system
(circle or Bain system) to ensure there are no visual holes or cracks
3. If there is no manometer on your breathing system, observe and listen for any
hissing of escaping air or use a detergent solution as described earlier
4. Open the pop-off valve to allow the O to be removed from the system by the
2

scavenger hose
a. This allows the O to move through the system and prevents soda lime dust
2

from moving into the breathing tubes

 5. Inflate the ET tube until there are no creases in the cuff. Leave inflated a minimum of
5 minutes to ensure there are no slow leaks (no obvious cracks or holes in the cuff)
C. Anesthesia machine concerns
1. Oxygen tanks must be turned off to prevent excess pressure on the regulators
2. Flush remaining O to minimize damage to pressure gauge and reducing valves
2

3. Turn flowmeter off to prevent sudden rush of O into the flowmeter when O is
2 2

turned back on. Do not overtighten, because the knobs can be easily twisted off
4. After each anesthesia induction, removable machine parts and anesthetic equipment
that have come in contact with the animal should be washed in a mild soapy solution,
soaked in a cold disinfectant, thoroughly rinsed, and air dried
5. The flutter valves and absorbent canister should be occasionally disassembled and
wiped dry. The unidirectional valves need periodic removal and cleaning with alcohol
or disinfectant to prevent adherence to the machine housing
6. Vaporizers should be turned off when not in use and periodically emptied to prevent
buildup of the preservative and other residue
a. Best to have machine evaluated, cleaned, and recalibrated by a biomedical
technician as per manufacturers guidelines and recommendations (e.g.,
usually every 6 to 12 months)
7. Barium hydroxide or soda lime granules found in the CO absorbers need replacing
2

when the granules have changed color or cannot be easily crumbled. Do not tightly
pack canister when filling, and leave about 2 cm (1 inch) of airspace from the top
a. Most canisters will have a fill line on them
b. Avoid having dust enter tubing or hoses of the machine
8. Rubber items will likely need to be replaced after prolonged use (degradation from
halogenated substances)

MONITORING TECHNIQUES
Central Nervous System
I. The objective of monitoring the CNS is to observe the patients reflex activity and to monitor the
degree of CNS depression. The signs you observe from monitoring may differ depending on the
species and the anesthetic agents being used. The following signs are general for domestic small
animals (e.g., cats and dogs)
A. Eye position
1. Eye position will rotate ventromedially during stage 3, plane 2 of anesthesia
2. Eye will return to central when the patient is too light or too deep
B. Palpebral reflex (blink)
1. Stimulated by lightly touching the medial or lateral canthus of the eyelids
2. Lateral palpebral reflex is eliminated before the medial palpebral reflex as the patient
becomes deeper
3. Reflex will become slow, weak, and then absent in stage 2, plane 2 with most inhalant
agents
4. If an analgesic has been given or injectable anesthesia alone is used, then a mild
medial palpebral reflex is acceptable
C. Corneal reflex
1. Stimulated by lightly touching the cornea of the eye
2. This reflex should be present under anesthesia
3. Absence of this reflex indicates anesthesia overdose
 4. Corneal reflex should only be used as the last possible resort to monitor the patient
due to the potential of injury
D. Pupil size
1. Generally dilated when the patient is in a light nonsurgical plane
2. Constricted in a light surgical plane
3. Dilated in a deep plane
4. Note that sympathetic responses, such as those to pain or certain drugs (e.g.,
atropine), will dilate the pupils
E. Pedal reflex (pain response)
1. Stimulated by pinching the skin between the toes
2. Normal response is to withdraw the leg
3. This response should become slower and weaker to absent as the anesthetic plane
becomes deeper, being completely eliminated by a light surgical plane
F. Jaw tone (muscle tone)
1. Stimulated by attempting to spread the jaws apart two to three times
2. Normal response is to resist
3. A good reflex to check before intubation
4. This response should become weaker as the anesthetic plane becomes deeper and
should be absent in a light surgical plane
5. If significant analgesic (e.g., CRI fentanyl) has also been used, mild jaw tone can
remain if all other monitoring signs indicate an appropriate plane of anesthesia
6. Some breeds will appear to have increased jaw tone because of increased muscle
mass in this area (e.g., Rottweiler)

Cardiovascular System
I. The objective of monitoring the cardiovascular system is to measure the heart rate and blood pressure
and to ensure that blood flow to the tissues is adequate
A. Heart rate
1. Most accurately measured with a stethoscope
2. Can also be measured by digital readout of mechanical monitoring equipment (e.g.,
electrocardiogram [ECG]) or audible equipment (e.g., Doppler monitor)
3. Normal rate under anesthesia is 70 to 140 beats per minute for dogs and 110 to 160
beats per minute for cats. Minimal acceptable heart rate in anesthetized dogs is
generally 60 beats per minute
4. Heart rate may decrease with deepening anesthetic plane but may also stay constant
or increase with a dangerously deep plane and/or with hypotension
5. Bradycardia (decreased heart rate) is not always a sign of deep anesthesia. Causes of
bradycardia include:
a. Drug effect (e.g., opioids, xylazine)
b. Anesthetic depth
c. End-stage hypoxia (e.g., respiratory obstruction)
d. Intermittent positive-pressure ventilation (IPPV)
e. Hypertension
f. Vagal nerve stimulation (e.g., surgically induced, intubation, pressure on
eye)
g. Hypothermia
h. Hyperkalemia
i. Myocardial ischemia
j. Hypoxemia (late sign)
 k. Fluid overload
6. Tachycardia (increased heart rate) is not always a sign of light anesthesia. Causes of
tachycardia include:
a. Pain
b. Hypoxemia
c. Hypercarbia
d. Ischemia
e. Anaphylaxis
f. Anemia, hypovolemia
g. Drug effects (e.g., ketamine, thiopental)
h. Fever
B. Pulse rate
1. Measure by palpation of an artery (rate and quality)
2. Pulse deficits (difference between heart rate and pulse rate) should be noted
C. Rhythm
1. Arrhythmias can be monitored by arterial palpation but are accurately monitored
with an ECG
2. Methods for monitoring heart rate: direct palpation, esophageal stethoscope,
Doppler monitor, and ECG
D. Blood pressure
1. Palpation of a peripheral pulse can indicate drastic increases or decreases in blood
pressure but not actual values
2. Blood pressure is more accurately measured by a noninvasive (indirect) or invasive
(direct) arterial blood pressure monitoring system. There are many commercially
available monitoring devices
a. Most will measure systolic, diastolic, and mean pressures and can be set to
read at regularly timed intervals (noninvasive) or continuously (invasive)
b. Commonly, pressures are read every 1 to 2 minutes (noninvasive)
3. Invasive (direct) blood pressures can be monitored through placement of arterial line
and provide a continual reading
a. Superior to indirect monitoring but may not be practical in regular practice,
because of the specialized equipment (e.g., arterial transducer, monitor) that
is necessary for this type of monitoring
4. Doppler unit is an indirect monitor, which is also affordable. It can give a fairly
accurate systolic pressure reading as well as audible heart sounds
5. Using an inappropriate cuff size on any blood pressure monitor will give you
distorted or false readings; therefore, ensure that you have a proper cuff size for the
patient
a. For example, if the cuff is too big, it will give lower readings. Conversely, if
the cuff is too small, it will give higher readings
6. Generally, blood pressure will decrease as the anesthetic plane deepens
a. Mean blood pressure in dogs should not be allowed to drop under 60 mm
Hg
b. Kidneys will become inadequately perfused below this level
c. This may result in renal impairment after anesthesia
7. Normal blood pressures
a. Systolic: 100 to 160 mm Hg
b. Mean: 80 to 120 mm Hg
c. Diastolic: 60 to 100 mm Hg
 8. Causes of hypotension
a. Hypovolemia
b. Shock
c. Drug effect (e.g., thiopental, inhalants)
d. Depth of anesthesia
9. Causes of hypertension
a. Pain
b. Hypercarbia
c. Fever
d. Drug effect (e.g., ketamine)
10. Methods for monitoring blood pressure
a. Direct palpation
b. Mucous membrane color
c. Capillary refill time (CRT)
d. Oscillometric blood pressure monitor (indirect)
e. Doppler monitor (indirect)
f. Invasive arterial catheterization (direct)
E. Capillary refill time
1. Acquired through digital compression on any nonpigmented mucous membrane.
Time between release of pressure and return of blood flow to the area
2. Normal CRT is less than 2 seconds
3. Good indication of how well cardiac output is affecting peripheral perfusion. It is
important to monitor this in conjunction with blood pressure
4. CRT will generally become longer with deepening anesthetic planes and
hypovolemia

Ventilation
I. ET tube placement
A. The technician intubating should inflate the cuff
B. Using a syringe, place small amounts of air into the cuff until there is slight backpressure on
the plunger of the syringe
C. Squeeze the reservoir bag to 20 cm of H O and listen to the gas flow in the patients
2

pharynx
D. There should be no sound of escaping gas
E. If escaping gas is evident, continue to add air to the cuff
F. Instill the smallest amount of air into the cuff to obtain a good seal
1. If the cuff is overinflated over a long period of time, there is the possibility of
creating necrosis of the trachea
G. Continue to monitor the ET tube cuff size throughout the anesthetic procedure
II. The objective of monitoring the ventilation/respiratory system is to ensure that the patients
ventilation is adequately maintained
III. Monitor rate and depth (character) of the ventilation
A. Under anesthesia, normal rate is 8 to 20 breaths per minute, and normal tidal volume is 10 to
15 mL/kg
IV. All induction drugs have the potential to cause a transitory apnea. One must monitor the
patients respiratory rate and O saturation carefully, beginning immediately on induction, to
2

ensure smooth transition to stage 3

A. In a very light plane of anesthesia, the ventilation will be irregular in depth and rate in
response to stimulation
 B. In a surgical plane, the rate and depth are generally regular
C. In a deep plane of anesthesia, breathing may become shallow and rapid, or both the rate and
depth may decrease
D. As the plane gets deeper, there will be some thoracic muscle paralysis, producing
paradoxical breathing (abdomen rises and chest falls during an inspiration)
V. Blood gas levels can also be monitored. The O levels will define the patients oxygenating ability
2

and the CO levels will define the ventilation status

2

A. Hypoventilation is indicated by increased CO levels (respiratory acidosis)

2

B. Hyperventilation is indicated by decreased CO levels (respiratory alkalosis)

2

C. Monitoring O levels may be performed using a pulse oximeter. However, this monitor will
2

display only O saturation and not CO levels

2 2

VI. Tachypnea (rapid breathing) may be a result of

A. Anesthetic depth
B. Hypoxemia
C. Hypercapnia
D. Hyperthermia
E. Postoperative pain
F. Drug induction (e.g., hydromorphone)
G. Individual variation (e.g., obesity, body position)
VII. Hypercapnia (increased CO ) may be a result of
2

A. Excessive depth of anesthesia

B. Airway obstruction
C. Thoracic or abdominal restrictive disease
D. Pulmonary disease
E. Dead space breathing
VIII. Ventilation/respiration system monitoring can be done using
A. Observation of chest wall and/or rebreathing bag movement
B. Auscultation of breath sounds
C. Respiratory monitors
D. Capnography (main-stream or side-stream)
1. Capnography is a graphic measurement of instantaneous CO of respiratory gases
2

displayed as a waveform on a monitor

2. It measures and works on the principle of infrared radiation absorption of CO 2

molecules
3. Provides information on the efficiency of ventilation through CO production,
2

alveolar ventilation, respiratory patterns, pulmonary perfusion, and elimination of

CO , as well as if there are any other problems (e.g., disconnections, leaks, esophageal
2

intubation)
4. End-tidal CO is the partial pressure at the end of expiration; however, for some
2

monitors, inhalant anesthesia concentrations can also be measured (e.g., inspired and
end-tidal concentrations, which are measured in % inhalant)
5. There are two types of capnography monitors: main-stream technology and side-
stream technology
6. Main-stream capnograph monitors are gas analyzers close to the patient (connector
fits between ET tube and breathing system)
a. Provides a real-time display of waveform
b. No sampling from the ET tube, and therefore do not need to scavenge
separately
c. Less expensive than the side-stream capnographs
 d. The sensor/adaptor puts weight on the ET tube; therefore, care must be
taken especially in small patients
e. Portable; however, easily damaged if sensor gets misplaced (falls on floor)
f. Unreliable on small patients
g. Moisture will build up over time, especially on long anesthesia cases
h. Cannot be used in large animals (horses, ruminants) due to issues with
moisture buildup
7. Side-stream capnograph monitors are gas analyzers inside a multifunctional monitor
(Figure 21-2)
a. Adaptor is lighter than main-stream adaptor, and therefore lighter on ET
tube
b. Samples gases (O , CO , inhalant) from the patient into specific tubing;
2 2

therefore, monitor must be scavenged

c. Not real time; therefore, a few seconds delay in waveform
d. Moisture is collected into a water trap, which must be drained and replaced
as required
e. Can use on large animals
f. Works well on small patients
g. More expensive than the main-stream capnographs

FIGURE 21-2 A multifunctional monitor showing ECG, heart rate, pulse oximetry (% O ), capnography (end-tidal CO ),
2 2

respiratory rate, inhalant isoflurane concentration, and temperature. Normal capnograph (last wave on Figure 21-2) shows
the waveform of varying CO levels during a normal breath cycle.
2

A-B: Baseline, start of expiration, anatomic dead space

B-C: Expiratory upstroke (gas exchange occurring at the alveoli)

C-D: Expiratory plateau (exchange of gas is complete)

D: End-tidal value of CO (normal ~ 35 to 45 mm Hg)

2

D-E: Start of inspiration

 E. Blood gas analysis
1. Analyzers measure pH, blood gases (PCO , PO ), electrolytes (Cl , Ca , K , Na ),
2 2
2 + + +

metabolites (glucose, lactate, creatinine, total bilirubin), and oximetry (hemoglobin, O 2

% saturation) parameters
2. Requires specialized blood gas syringes, which fit onto the analyzers aspirator.
Sample is automatically aspirated; parameters are selected and then analyzed
3. Printouts of the results are available for clinical viewing and interpretation
4. Analyzers Information Technology system can connect to certain hospital
information systems; therefore, results can directly be stored (and viewed) in the
patients electronic medical record

Oxygenation
I. The objective of monitoring oxygenation is to ensure adequate O concentration in the patients
2

arterial blood
II. Hypoxemia can be a concern
III. Causes of hypoxemia
A. Decreased inspired O concentration (e.g., O flow too low, especially when using N O)
2 2 2

B. Hypoventilation while inspiring 21% O (which is room air)

2

C. Venous admixture (e.g., bronchoconstriction, atelectasis, shunting)

IV. Mucous membrane color
A. Generally pink in unpigmented areas
B. Mucous membranes may change color to a gray tinge or blue with decreased O levels in the
2

blood
1. However, this change may be delayed and is not considered a good forewarning
C. High CO due to hypoventilation may produce a very bright pink, vasodilated mucous
2

membrane
D. Pale mucous membranes may occur with anemia or hypothermia, or with light planes of
anesthesia when pain is occurring
V. Oxygenation monitoring can be done using
A. Observation of mucous membrane color
B. Pulse oximetry
C. Oxygen analyzer
D. Blood gas analysis

Fluids
I. The objective of monitoring fluids during anesthesia is to ensure adequate blood volume and cardiac
output, and to replace insensible losses
A. Furthermore, to maintain intravenous access in case you have an emergency situation

Temperature
I. The objective of monitoring a patients temperature is to ensure that the patients natural
homeostasis is adequately maintained
A. Decreases in body temperature and slow metabolism can reduce the amount of anesthetic
agent required
B. It is very important to monitor and support body temperature from the time of sedation
through to recovery
II. Hypothermia: develops when the thermoregulation fails to control the balance between metabolic
heat production and environmental heat losses (< 95 F [< 35 C]). All patients are at risk
 A. Concerns with hypothermia include: decreased metabolic rate, bradycardia, and further
CNS depression; therefore, it is important to quickly warm up the patient
B. Hypothermic patients should be actively rewarmed to 99 F (37.5 C), after which heat
sources should be removed to prevent hyperthermia
C. It is very important in patient medical care to help your patient to fully recover with SAFE
warming tools (e.g., water bottles, Bair Hugger)
1. Placing a recovering animal on a heating pad unattended is not recommended
2. To prevent burning the patient, any heat source used should not produce heat over
107.6 F (42 C)
3. Physical sources of heat should be wrapped in a towel before placement against the
patient
4. Continual postoperative monitoring of the heating sources is also needed to make
sure that the patient does not become cold, causing further temperature issues
III. Hyperthermia: increased temperature (> 104 F [> 40 C]) has harmful effects that are
primarily related to high metabolic activity and cellular O consumption
2

A. Causes of hyperthermia include excessive heat application, drug interaction, or genetic

defect (e.g., malignant hyperthermia syndrome)
IV. Temperature monitoring can be done using either a thermometer (monitor rectal or axillary
peripheral temperature) or an esophageal probe (monitor core temperature)

Equipment
I. The objective of anesthesia equipment monitoring is to ensure that the equipment used to support
and monitor the patient is in good working order and properly calibrated
II. Review Health Hazards and Environmental Concerns section
III. Review Equipment Maintenance and Concerns section
IV. Equipment monitoring includes:
A. Knowing your machine thoroughly, so that you can troubleshoot in an emergency or after
common mishaps (e.g., exhausted soda lime, O depleted, O flowmeter accidentally turned
2 2

off, accidentally closed pop-off valve, leaky ET tube, leak in anesthesia machine)
B. Pressure testing (e.g., anesthesia machine, bags, hoses, ET tubes)
C. Routine maintenance on the anesthesia machine (e.g., servicing machine and vaporizer)
D. Proper equipment monitoring will prevent some common mishaps, as previously mentioned

STAGES OF ANESTHESIA
I. Ideally, a smooth induction goes from stage 1 to stage 3, quickly bypassing stage 2
II. Stage 1
A. Induction stage, stage of analgesia and altered consciousness
B. From beginning to loss of consciousness
C. Sensations become dull
D. Loss of pain
E. Pupils are normal in size, then begin to dilate when entering stage 2
F. Blood pressure may be elevated
G. Respiration rate is generally increased, may be irregular
H. Vomiting, retching, and coughing may occur
III. Stage 2
A. Stage of delirium or excitement, loss of consciousness
B. Excitement and involuntary muscular movement
1. May appear to struggle
 C. Eyes closed, jaw set
1. Reflexes present, may be exaggerated
D. Pupils dilated, light reflex still present
E. Respiration irregular
1. Panting or breath holding is common
F. Vomiting may occur
IV. Stage 3
A. Stage of surgical anesthesia
B. Respiration full and regular
C. Pupils begin to constrict
D. Palpebral blink is absent
E. Four substages (planes)
1. Plane 1
a. Eyeball begins to roll, pupil is light responsive, and medial palpebral reflex
still present
b. Muscle tone still present
c. Pain reaction still present
d. Respiration is half thoracic and half abdominal
e. Blood pressure and heart rate are normal
2. Plane 2
a. Ideal surgical plane
b. Respiration becomes deep and regular
c. Fixed eyeball, often rotated ventrally; sluggish pupillary response
d. Increase in heart and respiratory rate is mild in response to surgical pain
e. Peripheral reflexes (e.g., pedal, palpebral) are absent
3. Plane 3
a. Increased abdominal respiration, delayed thoracic inspiratory effort
(intercostal paralysis)
b. Respiration rate decreases, breaths are no longer deep and regular
c. Eyeballs fixed and usually centrally rotated
d. Pupils begin to dilate
e. Pulse fast and faint
f. Blood pressure decreased; fails to respond to surgical pain stimulation
4. Plane 4
a. Progressive respiratory paralysis
b. Tidal volume decreased
c. Palpebral and corneal reflexes absent
d. Pupils dilated and not light responsive
e. Heart rate decreased, blood pressure significantly low
f. Apnea or jerky inspirations
g. Pale mucous membranes and prolonged CRTs
V. Stage 4
A. Stage of medullary paralysis
B. Apnea
C. Cardiac arrest

VENTILATION
I. Assisted (occasional sigh or additional breaths) or controlled (IPPV)
II. Manual or mechanical
III. Goal is to maintain near-normal acid-base status and oxygenation, and to counteract CO retention
2

IV. In some cases, only assistance is needed (e.g., obese patient, patient in head-down recumbency,
hypothermia, pulmonary disease)
V. Occasional sighing or bagging of the patient (e.g., once or twice a minute) may
achieve these goals
A. To properly bag an animal, close the pop-off valve, apply steady pressure to the bag, release
and IMMEDIATELY reopen the pop-off valve
B. When squeezing the bag, it is important to make sure that the manometer reading stays
below 20 cm H O2

VI. In many cases, it is necessary to control the ventilation using IPPV

A. Use with neuromuscular blocking agents; with thoracic surgery, diaphragmatic hernia, or
gastric torsion; or with any patient that is obviously hypoventilating
VII. Observe guidelines and reassess results continually
A. Rate: 8 to 12 breaths per minute
B. Inspiration-to-expiration ratio should be 1:2
C. Tidal volume: 15 to 20 mL/kg (30 mL/kg for open chest)
D. Inspiratory pressure: 12 to 20 cm H O (30 cm H O with open chest)
2 2

E. The goal of using these parameters is to decrease CO levels to slightly below normal, thereby
2

eliminating spontaneous breathing and allowing control of ventilation

VIII. In most cases, it is not necessary to use a neuromuscular blocking agent to perform IPPV
IX. A CO monitor (i.e., capnograph) is a useful device that measures end-tidal CO
2 2

A. A normal reading should be between 35 and 55 mm Hg

B. CO should never be allowed to go above 60 mm Hg
2

C. Hyperventilation in cases involving possible brain herniation, tumor, or intracranial pressure

increases should be adjusted so that the CO readings are below 30 mm Hg
2

X. Double-check all ventilation with visualization for normal chest movement

A. Reassess the patients other parameters
1. Mucous membrane color, CRT, heart rate, pulse strength, and blood gases when
available
XI. Concerns with ventilation
A. Ventilation has a larger tidal volume than a patients normal spontaneous tidal volume;
therefore, more anesthetic agent will be delivered. Generally the percentage of inhalant
anesthetic is decreased
B. If the patient breathes spontaneously while IPPV is performed, it is an indication of
1. Underventilation: an indication for you to increase the minute volume by increasing
the rate and/or volume of breaths
a. Patient is in pain: increase the level of inhalant anesthetic if possible, add
N O, or give intraoperative analgesics (e.g., opioids)
2

b. Patient is at a light anesthetic plane

c. If you are ventilating adequately, the patient will not attempt to breathe
spontaneously
2. Overventilation
a. Overventilation has potential to damage an animals lungs
(1) Rupture of alveoli, leading to pneumothorax or mediastinal
emphysema
b. Decreased cardiac output and venous return
c. Excessive decrease in CO , leading to respiratory alkalosis
2

C. Patient with a pneumothorax will have to be ventilated with caution

 1. This means ventilating with a smaller tidal volume, lower pressures, and higher rates
(breaths per minute)
2. Be prepared for the development of a tension pneumothorax
D. Tension pneumothorax is indicated by increased pressures with chest expansion, which is
seen on the pressure manometer (anesthesia machine or ventilator manometer) and/or may
be felt when squeezing the rebreathing bag becomes more difficult
E. When removing the patient from the ventilator, continue to ventilate for several minutes after
turning off the inhalant anesthetic
1. This will help eliminate the inhalant from the patients system and speed
recovery
2. Also, decrease the minute volume (rate and/or tidal volume) to allow the CO levels
2

to increase slightly in the patients system and to stimulate the patient to breathe
spontaneously

ACID-BASE BALANCE
Acid-base balance is defined by pH, which is the result of processes in the body tending toward acidosis or
alkalosis.
I. Mechanisms that regulate pH are respiratory or metabolic in nature and are maintained by three
systems
A. Chemical buffers
1. Bicarbonate (carbonic acids)
2. Phosphate (red blood cells, kidneys)
3. Hemoglobin
B. Respiratory system
1. By breathing and alternating the CO , the lungs can regulate the concentration of
2

carbonic acid
C. Renal system
1. Elimination of excess acids or bases: carbonic acidCO equilibrium
2

2. CO + H O = H + HCO (respiratory) (metabolic)

2 2
+
3

II. Four categories of acid-base disturbances

A. Respiratory acidosis
1. CO production is greater than CO excretion
2 2

2. Indicated on blood gas analysis by an increase in CO levels

2

3. Caused by anything that depresses ventilation (hypoventilation) and impairs

excretion of CO (e.g., deep anesthesia, pulmonary disease, respiratory obstruction)
2

4. May also be caused by increased CO production with malignant hyperthermia

2

5. Increase in CO level causes a gain in acids; therefore, the pH decreases

2

6. Other signs: increased cardiac output (hypertension), vasodilation, and ventricular

arrhythmias
7. Natural compensation by the body with time through the kidneys (although chronic
hypercapnia is rare)
8. Respiratory acidosis can be treated by
a. Ventilating the patient with a higher minute volume (increase the tidal
volume and/or respiratory rate) than what the patient was breathing
spontaneously to help remove some of the CO 2

b. Treatment of the underlying disease (e.g., pneumonia)

B. Respiratory alkalosis
1. CO excretion is greater than CO production
2 2
 2. Indicated on blood gas analysis by a decrease in CO levels 2

3. Caused by excessive controlled ventilation (IPPV) or anything that stimulates

spontaneous hyperventilation (such as pain and excitement)
4. Causes excess loss of H and gain in bases
+

5. Other signs: may produce tachycardia and ECG changes

6. Natural compensation by the body with time through the kidneys, although chronic
hypocapnia is rare; therefore, compensation is seldom seen
7. Respiratory alkalosis can be treated by
a. Decreasing the minute volume if the patient is being ventilated
b. If the patient is breathing spontaneously and hyperventilating, assess and
treat the cause of hyperventilation (e.g., light anesthesia plane, pain)
C. Metabolic acidosis
1. Indicated on blood gas analysis by low adjusted base excess (ABE) or low HCO 3

2. Common causes are lactic acid gain (commonly caused by decreased tissue
perfusion), renal failure, body secretions rich in HCO that are lost and not
3

reabsorbed (e.g., from diarrhea)

3. Causes loss of HCO , which means an H gain
3
+

4. Natural compensation by rapid response of respiratory system by hyperventilating

5. Metabolic acidosis can be treated
a. For mild imbalance, treat with a replacement crystalloid, e.g., Lactated
Ringers (lactate) or PL-A (acetate, gluconate)
b. For more severe imbalances, treat with sodium bicarbonate
(1) Dose is calculated as follows: ABE (value) Wt (kg)
0.3 = ___ mEq of Na bicarbonate
+

(2) This volume should be given slowly IV (over 15 to 30 minutes)

(3) Deaths have occurred during fast administration of sodium
bicarbonate in dehydrated animals
(a) HCO combines with H to produce CO and H O
3
+
2 2

(b) CO will rapidly enter the brain

2

(c) HCO will take longer to enter into cells

3

(d) Excess CO in the brain will drop the pH of the CNS

2

further, resulting in coma and death

(e) Paradoxical CNS acidosis
D. Metabolic alkalosis
1. Indicated on blood gas analysis by high ABE or high HCO 3

2. Caused by vomiting (loss of H ), hypochloremia (increased renal absorption of

+

HCO ) 3

3. Natural compensation through the respiratory system by hypoventilation, resulting

in a mild respiratory acidosis
4. Metabolic alkalosis can be treated, if severe, by replacing the missing element
a. Potassium replacement may be necessary if patient is hypokalemic
b. Chloride replacement may be necessary in the vomiting patient
III. Interpretation of blood gas results
A. Normal values
1. pH: 7.35 to 7.45
2. PO
2

a. 400 to 500 mm Hg (arterial, 100% inspired O ) 2

b. 150 to 250 mm Hg (arterial, N O:O mix inspired)

2 2

c. 90 to 100 mm Hg (arterial, 21% O inspired [room air])

2
 d. 50 to 200 mm Hg (venous, 100% inspired O ) 2

e. 30 to 60 mm Hg (venous, 21% O inspired [room air])

2

3. PCO : 35 to 45 mm Hg (arterial, will increase by 6 mm Hg with venous sample)

2

4. HCO : 20 to 24 mEq
3

5. ABE: 4 to + 4
B. When interpreting values from a blood gas sample, there may be two disorders: a primary
disorder and a secondary (compensating) disorder
1. First look at the pH
a. pH less than 7.35 indicates an acidosis
b. pH greater than 7.45 indicates an alkalosis
2. Then look at the PCO and ABE to determine respiratory and metabolic conditions,
2

respectively
3. Generally the pH will vary in the direction of the primary disorder
4. Generally the component with the greatest change is the primary disorder
a. Natural compensation is usually not 100%, and seldom will there be an
overcompensation
(1) PCO greater than 45 mm Hg indicates respiratory acidosis
2

(2) PCO less than 35 mm Hg indicates respiratory alkalosis

2

(3) ABE less than 4 mm Hg indicates metabolic acidosis

(4) ABE greater than + 4 mm Hg indicates metabolic alkalosis
(5) ABE considers any alteration in PCO and adjusts, so even if the CO
2 2

is abnormal, the ABE can be relied on to determine the metabolic

state
(6) HCO can be used as an indication of metabolic state if the CO is
3

2

normal
(a) HCO less than 20 mEq indicates metabolic acidosis
3

(b) HCO greater than 26 mEq indicates metabolic alkalosis

3

OXYGENATION AND ANESTHETIC EQUIPMENT PROBLEMS

I. If the patient seems to be poorly oxygenating, it may be from something as simple as a mechanical
problem, such as a detached ET tube, a disconnected or leaking rebreathing bag, or a kinked or
blocked breathing hose or ET tube
A. The correction for such problems is obvious once the problem is isolated
1. If the rebreathing bag is empty, the flow rate could be too low or the flowmeter could
be off
2. An overdistended bag could be because of a pop-off valve that was inadvertently
closed, a flow rate that was too high, or poor scavenging
3. A leak in the system may be because of a hole in the rebreathing bag or tubing,
disconnected or leaking tubes or rebreathing bags, or a problem with the scavenging
system
II. If a patients anesthesia level seems light, the problems may be because of
A. An empty vaporizer, one that is not working properly, or an inadequate setting
B. Hoses or attachments that are not properly placed
C. There may be excessive CO buildup because of an exhausted CO absorbent or sticky
2 2

unidirectional valves
III. If a patients anesthesia level seems deep, the problems may be because
A. The vaporizer may be set too high or not working properly
B. Patient may be severely hypercapnic or hypoxic or may be hypotensive
 IV. Other problems may be clinical problems, such as pneumonia, lung pathology, diaphragmatic
hernia, and pulmonary edema
A. If a general anesthetic is used in these cases, oxygenation may be improved by assisting or
controlling the ventilation
B. Prior to general anesthesia, patient should be preoxygenated with 100% O that is delivered
2

through a face mask or nasal cannula

CHAPTER 22

Pain Management
THE ROLE OF THE VETERINARY TECHNICIAN/NURSE IN PAIN
MANAGEMENT
I. Becoming a patient advocate
A. Veterinary technicians are in the unique position of being responsible for most of the quality
of patient care without the freedom to prescribe or initiate therapy
B. Knowledge of the physiology of pain and pharmacology of analgesics is essential for good
communication between veterinarians and veterinary technicians
C. The skilled technician is a source of vital information required to choose and administer
appropriate analgesics
D. Familiarity with patient personalities and reactions to stimuli give additional insight into
how particular patients may react to painful stimuli
1. Look for differences in expression between dogs and cats, and young and old, and
for variations among breeds
E. Familiarity with the current principles of pain management, including preemptive and
multimodal therapies and prevention of the wind-up phenomenon, are vital and must
be put into practice
F. The roles of the veterinary technician in pain management include:
1. Patient assessment
2. Providing nonpharmacological comfort and care
3. Differentiating pain from other stress
4. Requesting appropriate analgesia and sedation
5. Administering medications and performing analgesic techniques
6. Monitoring and treating drug effects
7. Assessing patients after surgery
8. Communicating with clients about hospital and at-home care
9. Logging controlled substances
II. Communication
A. Communication among all members of the entire health care team, including veterinarians,
veterinary technicians and nurses, assistants, and pet owners, is essential for consistent pain
management
 B. Veterinary technicians have the responsibility of continually monitoring their patients and
often develop a sense of which analgesics seem to work best under various circumstances
C. Based on his or her interaction with patients, the technician may offer suggestions for
adjustments in analgesic regimens, changes or additions to drug protocols, or the possible
addition of sedatives, if needed
D. Technicians should provide as much feedback as possible as to which analgesic protocols are
working well and which need to be improved to increase patient comfort
1. Discussion about each case directly with the clinician should address particular
concerns or expectations, potential for adjustments in analgesic regimens (as-needed
injections to a constant rate infusion [CRI]), changes or additions to drug protocols
(adding a nonsteroidal antiinflammatory drug [NSAID] or an adjunctive analgesic), or
the possible addition of sedatives if needed
E. Pain management issues, such as the appearance and behavior of the patient that prompted
the administration of analgesics; the type, dose, and timing of previous analgesic
administration; and the response and any adverse reactions after administration, should be
described to all those caring for the animal and recorded in the medical record
F. Do not quit until pain quits
1. Pain medications prescribed by the patient's veterinarian need to be sent home with
patients
2. The owners must be educated to recognize signs of pain in their animal
3. Owners must be educated in administering the medications
4. Owners must be able to judge if the analgesic is effective and be encouraged to
request additional analgesia if the pets pain persists beyond the anticipated
period
III. Recognition of pain in animals
A. Small animals
1. Pain has become the Fourth Vital Sign, by the AAHA/AAFP Pain
Management Guidelines for Dogs and Cats, 2008 ranking in equal importance with
temperature, pulse, and respiration.
2. Physiological signs of pain
a. Increased heart rate, increased blood pressure, increased respiratory rate,
and vocalization
3. Behavioral signs of pain (Table 22-1)
a. General restlessness, decreased appetite, not sleeping, resentment of being
handled, and assuming an abnormal position

TABLE 22-1
Species-Specific Behavioral Signs of Pain

Species Vocalizing Posture Locomotion Temperament

Dog Whimpers, Cowers, crouches; Reluctant to move; Varies from chronic to acute;
howls, recumbent awkward, shuffles can be subdued or
growls vicious; quiet or restless
Species Vocalizing Posture Locomotion Temperament

Cat Generally silent; Stiff, hunched in Reluctant to move limb, Reclusive

may growl sternal carry limb
or hiss recumbency;
limbs tucked
under body

Primate Screams, grunts, Head forward, arms Favors area in pain Docile to aggressive
moans across body;
huddled,
crouching

Mouse, rat, Squeaks, squeals Dormouse posture; Ataxia; running in circles Docile or aggressive
hamster rounded back; depending on severity of
head tilted; back pain, eats neonates
rigid

Rabbit Piercing squeal Hunched; faces back of Inactive; drags hind legs Apprehensive, dull,
on acute cage sometimes aggressive
pain depending on severity of
pain; eats neonates

Guinea pig Urgent repetitive Hunched Drags hind legs Docile, quiet, terrified,
squeals agitated

Horse Grunting, nicker Rigid; head lowered Reluctant to move; walk Restless, depressed
in circles, up
and down
movement

Chicken Gasping Stands on one foot, None Lethargic, allows handling

hunched, huddled
Species Vocalizing Posture Locomotion Temperament

Cow, calf, Grunting; Rigid; head lowered; Limp; reluctant to move Dull, depressed; acts violent
goat grinding back humped the painful area when handled
teeth

Sheep Grunting; teeth Rigid; head down Limp; reluctant to move Disinterested in surroundings;
grinding the painful area dull, depressed

Pig From excessive All four feet close Unwilling to move; From passive to aggressive
squealing to together under unable to stand depending on severity of
no sound at body pain
all

Bird Chirping Huddled, hunched From excessive Inactive; drooping, miserable

movement to tonic appearance
immobility
depending on
severity of pain

Fish None Clamped fins; pale None unless forced; if a First sign to occur is anorexia;
color; hiding; schooling fish, will lethargic; stressed easily
anorexia separate itself from
others

Amphibian None Closed eyes; color Immobility; lameness Anorexia; aggressive

changes, rapid
respirations

Reptile Hiss; grunting Hunched; hiding; color Immobility unless forced Anorexia; aggressive;
change lethargic; avoidance
This chart is meant to display some of the different signs species may exhibit if in pain. Individuals may not show any of these signs
or they may show signs not listed. This is meant as a general guide.
4. Clinical signs of pain
a. Tachycardia, tachypnea, restlessness, increased temperature, increased blood
pressure, abnormal posturing, inappetance, aggression, frequent movement,
facial expression, trembling, depression, and insomnia
5. Less frequently reported clinical signs
a. Anxiety, nausea, pupillary enlargement, licking, chewing, staring at the
surgical site or wound, poor mucous membrane color, salivation, decreased
CO , and head pressing
2

6. The clinical manifestations may be quite different between species and even among
different members of the same species
B. Large animals
1. General signs of pain
a. Decreased interest in food to anorexia, lethargy, excitement, restlessness,
pawing, vocalizing (especially cattle), bruxism, reluctance to move, lying
down more frequently or for longer periods than usual
b. Any abnormal behavior
2. Additional signs of gastrointestinal (GI) tract pain
a. Kicking or looking at abdomen, violently trying to roll, stretching out in
abnormal posture (especially horses), standing with abdomen tucked
(especially cattle), dog sitting (especially foals with GI pain)
3. Additional signs of musculoskeletal pain
a. Lameness, abnormal gait, positive response to hoof testers or flexion tests
4. Other signs of pain (horses only)
a. Reluctance to be bridled (may be head or teeth pain)
b. Reluctance to be saddled (may be back pain)
c. Reluctance to be ridden (may be back pain, lameness, or general pain)
IV. Pain charts and scales
A. Pain scales can be visual analog scales (VAS), numerical rating scales, or simple descriptive
scales (see Web Fig. 22-1)
WEB FIGURE 22-1 Colorado State University (CSU) acute animal pain scales developed by P. Hellyer et al at CSU for
assessing pain in dogs (A) and cats (B). Available at www.IVAPM.org. (From Bassert JM, Thomas J: McCurnin's clinical textbook for veterinary
technicians, ed 8, St Louis, Elsevier Saunders, 2013.)
B. Pain assessment
1. A VAS designed for use in nonverbal human patients uses pictorial rather than
numerical rating systems
2. Veterinary VASs typically use subjective numerical ratings where zero correlates
with no pain, and the highest number is the worst pain imaginable for that particular
procedure
3. In addition to the VAS score, a complete patient description including physiological
signs (temperature, pulse, respiration) and behavioral signs (vocalization, posturing,
eating, and sleeping habits) should be documented in the medical record
4. Pain assessments should be made at 4- to 6-hour intervals throughout hospitalization
in the general patient population
5. During the immediate postoperative period and throughout the critical phase,
patients should be monitored as often as every 30 minutes
6. Ideally, assessments on an individual patient are performed by the same person over
time
7. Repeat recorded assessments allow for evaluation of the efficacy of analgesic
protocols and make response to specific drugs easier to track
C. Distinguishing between pain and dysphoria (Table 22-2)
1. Dysphoria is a medically recognized mental and emotional condition in which a
person experiences intense feelings of depression, discontent, and in some cases
indifference to the world around him or her
2. Veterinary postoperative patients frequently display aberrant behavior for several
minutes and up to hours postsurgery
3. These behaviors may include vocalization, thrashing, rolling, self-mutilation, and
tachypnea
4. When these behaviors are thought to be related to stress other than pain, they are
often referred to as dysphoria
5. Abnormal postoperative behaviors are sometimes referred to as emergence
delirium attributed to residual gas anesthetics
6. Some animals do in fact display this response upon awakening, but anesthetic-
related behaviors should resolve within several minutes
a. Behaviors that persist beyond a few minutes require further investigation
and attention
7. Differentiating between pain and dysphoria following drug administration or use of
anesthetics is critical to provide appropriate treatment
8. Most animals in pain will be able to be temporarily soothed by a technician speaking
in low tones during a petting interaction, although painful behaviors normally resume
when the technician leaves the cage
9. These patients appear to recognize that someone is with them and usually make eye
contact
a. A patient who stops the abnormal behaviors in the presence of a calming
person is likely to be in pain rather than having a drug reaction
10. Animals in pain will also respond when the suspected focus of pain is gently
palpated
 11. These two findings should confirm the suspicion of pain and prompt the
administration of additional analgesics
12. Patients who appear delirious and cannot be calmed are more likely to be
experiencing stress or a narcotic reaction and will more likely benefit from sedation
13. These patients typically do not seem to recognize that a human is with them, do not
make eye contact, and do not necessarily respond to light palpation of painful sites
14. The practice of reversing analgesics is reserved for patients who do not respond to
either of the above approaches and/or whose physiological condition is of
immediate medical concern

TABLE 22-2
Drugs Used for Dysphoria or Emergence Delirium

Drug Dose Comment

Acepromazine or Low premed dose

benzodiazepine

Propofol 0.25-0.5 mg/kg IV Low dose

Butorphanol 0.02 mg/kg diluted to 5 mL and give

1 mL every few minutes

Naloxone Increments of 0.5-1 mL/min until panting, Dilute 0.1-0.25 mL of naloxone (0.4 mg/mL
drooling, or dysphoric signs start to concentration) in 5-10 mL of sterile saline
subside, then stop

Dexmedetomidine 0.5-1 mcg/kg bolus Old animallow dose

Young, bouncy, angry animalhigh dose

2 g/kg/hr CRI dose for continued

dysphoria/anxiety/pain in dogs and cats

NEUROPHYSIOLOGY OF PAIN*
I. Basics of pain physiology
A. The most often quoted definition of pain comes from the International Association for the
Study of Pain (IASP): an unpleasant sensory and emotional experience associated with
actual or potential tissue damage
B. Pain is acknowledged to be a complex, multifaceted experience that encompasses
1. A sensory component (what happens in the receptors and neurons)
2. An emotional component (this is the suffering aspect of pain)
3. A cognitive component (the perception part of the pain experience, the recall and
influence of previous pain experiences, perceived threats, etc.)
II. An addendum to the IASP definition of pain is particularly relevant to veterinary patients
A. The inability to communicate verbally does not negate the possibility that an individual
is experiencing pain and is in need of appropriate pain-relieving treatment
III. Pain has both subjective and objective components, potentially of variable proportion, but all of
which must be treated
A. When pain is present and unrelenting, whether acute or chronic, it overtakes and includes
every other life experience at that time
IV. Peripheral nociception
A. The noxious stimulus/injury leading to the pain experience may result from a mechanical,
chemical, or thermal event
B. Nociception is the activity in the peripheral pathway that transmits and processes the
information about the stimulus to the brain
1. Pain is the perception of nociception, which occurs in the brain
C. There are four basic steps that occur along the pain pathway leading to the experience of
pain (Figure 22-1)
1. Transductionthe process by which afferent nerve endings translate the noxious
stimulus into nociceptive impulses. The nerve fibers that respond maximally to
noxious stimulation are referred to as nociceptors
a. Types of afferent nerves
(1) A beta fibers: myelinated; large diameter; respond primarily to
light touch and vibration
(2) A delta fibers: myelinated; small diameter; fast transmission;
intense, prickling pain
(3) C fibers: unmyelinated; slow transmission; polymodal (mechanical,
thermal, and chemical); burning, aching pain
2. Transmissionthe process by which impulses are sent to the dorsal horn of the
spinal cord, and then along the sensory tracts to the brain
3. Modulationtakes place primarily in the dorsal horn of the spinal cord, but also
occurs elsewhere in the nervous system with input from both ascending and
descending pathways. Additional modulation occurs in the midbrain, home of the
hypothalamus
4. Perceptionrefers to the subjective experience of pain
FIGURE 22-1 Nociception. Sites of analgesic action along the pain pathway. (From Tranquilli WJ, Grimm KA, Lamont LA: Pain management for

the small animal practitioner, Jackson, Wyo, Teton NewMedia, 2004.)

V. Acute pain (adaptive)
A. All tissue injury, whether intentional (e.g., surgery) or unintentional (e.g., hit by car,
laceration, crush injury), causes pain
B. There are pain-induced stress responses in the body that can lead to pain-induced pathology
C. Acute pain is typically described as having a sudden, recent onset
D. There is an obvious, identifiable cause such as an injury, disease, or surgery
E. It is typically time limited and of relatively short duration
F. The intensity can be highly variable, depending upon the severity of the cause
G. Inflammatory pain occurs as a result of unplanned injury (think sprain or strain) or planned
injury (think surgery or radiation therapy), and in some chronic pain states such as
osteoarthritis (OA)
1. Inflammatory pain protects us from ongoing tissue damage
H. In the face of inflammatory pain, the bodys focus shifts from protecting the body
against tissue damage to promoting healing of the damaged/injured tissue
I. This acute pain is the predicted physiological response to the noxious stimulus
J. Remember, adaptive pain = good pain (Box 22-1)

BOX 22-1
N e g a t i v e E ff e c t s o f P a i n o n A l l M a m m a l s
Cardiovascular System
Arrhythmias

Gastrointestinal System
Nausea, vomiting

Pulmonary System
Tachypnea
Hypoxemia
Pulmonary edema
Pulmonary hypertension
Respiratory acid-base imbalance

Renal System
Renal hypertension

Metabolic System
Cachexia
Increased oxygen demand
Negative nitrogen balance

Immune Function
Hemorrhage

Sleep Pattern
Behavior changes

VI. Chronic pain (maladaptive)

A. The IASP defines it as pain without apparent biological value that has persisted beyond
the normal tissue healing time usually taken to be 3 months
B. It is either pain that exists in the absence of disease, or pain that is disproportionate to the
organic disease
C. Maladaptive pain = bad pain (or, pain as disease)
D. Any stimuli to the affected area that would normally be innocuous become noxious
1. We may experience a reduced threshold; less stimulation leads to pain that is termed
allodynia
E. Pain may increase due to a response to the stimulus or hyperalgesia
F. Acute pain can become chronic pain by progressing through three phases
1. Phase 1: brief trauma or noxious stimulusphysiological pain
2. Phase 2: prolonged noxious stimulationpersistent pains leading to tissue damage
and inflammation
a. During this phase, changes in the central nervous system (CNS) can begin to
occur
b. Hyperalgesia can develop
3. Phase 3: neurological damage, including peripheral neuropathies and central pain
states
a. These pains are activated by innocuous stimuli or are amplified responses to
minor stimuli
 VII. Neuropathic pain
A. Neuropathic pain is an important maladaptive pain state
B. It may occur as a result of damage to a peripheral nerve
C. These patients may have had an amputation, a trauma resulting in nerve damage (e.g., radial
nerve trauma), or a stretching injury such as brachial plexus stretching
D. Another scenario that may lead to neuropathic pain is the patient with severe OA and
degenerative joint disease where the bony changes impinge upon peripheral nerves
E. One more neuropathic pain scenario involves trauma to the spinal cord (i.e., a ruptured
intervertebral disc with subsequent trauma to the cord)
F. Finally, we may also have spontaneous pain hypersensitivity in response to a brain injury
such as a stroke
VIII. Peripheral and central sensitization
A. Peripheral sensitization occurs when tissue inflammation leads to the release of a complex
array of chemical mediators, resulting in reduced nociceptor thresholds
1. This causes an increased response to painful stimuli (primary hyperalgesia)
2. A good example of this is the change in heat sensitivity after sunburn, when a
normal arm stimulus such as a shower feels burning hot in the sunburned areas
B. Central sensitization refers to an increase in the excitability of spinal neurons, mediated in
part by the activation of N-methyl-D-aspartate (NMDA) receptors in dorsal horn neurons
1. The net effect is expanded receptor fields (pain in neighboring areas not subjected to
injury, or secondary hyperalgesia) and painful responses to normally innocuous
stimuli (mediated by A beta fibers and referred to as allodynia)
C. The combination of peripheral and central sensitization results in an increase in the
magnitude and duration of pain
IX. Wind-up
A. Pain wind-up is the perceived increase in pain intensity over time when a given painful
stimulus is delivered repeatedly above a critical rate
1. An example of this is a cat with long-standing OA and degeneration of the spine that
may not tolerate even light brushing because it is too exquisitely painful

CLINICAL APPLICATIONS
I. Acute pain
A. Perioperative
1. Perioperative analgesia has huge advantages
a. Analgesia improves our medical success rate because adequate analgesia
improves healing and allows a decreased incidence of postoperative stress-
related complications
b. Pain initiates a fairly profound stress response and a sympathetic overdrive
c. Stress and autonomic imbalance are not benign, and the cascade of side
effects includes GI ileus, GI ulceration, clotting dysfunction, hypertension,
tachycardia, tachyarrhythmias, and many others
d. Stress and pain cause a fairly marked increase in cortisol release and a
substantial increase in energy requirements, the latter of which may lead to a
negative nitrogen balance and both of which impair healing
e. Analgesia increases anesthetic safety
f. Inhalant anesthetics block only the portion of the pain pathway known as
perception; all of the other components of the pathway continue to function,
and stimulus of the pathway can result in arousal from anesthesia
 g. Analgesia increases anesthetic safety by allowing a decrease in the dosages
of anesthetic drugs that are required to produce sleep
h. Most anesthetic drugs, including the anesthetic gases, block the brain's
response to pain but do not actually block pain
i. If the pain is severe enough, the brain can still respond and make the animal
appear to be inadequately anesthetized
(1) Remember, the adverse effects of most drugs, including anesthetic
drugs, are dose dependent
j. The appropriate response is to decrease the pain with analgesics and
maintain anesthesia at a light, safe depth
k. Aggressive analgesia at the time of surgery decreases the likelihood of
persistent pain
l. Patients that are already in pain will need more aggressive perioperative
pain management
2. If we follow the three basic principles of pain management, we will be able to
provide appropriate analgesia for any patient in our hospital. The three principles are:
a. Analgesic drugs should be administered preemptively
(1) Analgesia provided prior to the pain stimulus, or preemptive
analgesia, is more effective than analgesia provided once pain
has occurred because preemptive analgesia prevents or alleviates the
hypersensitization of the pain pathways, thus making pain easier to
control with conventional drugs and techniques
(2) Because animals try to hide pain when at all possible, it is likely
that once pain is so severe that the animal can no longer hide the
pain, the hypersensitization process has begun and pain will be
more difficult to treat
(3) Depending on which drug(s) we use, preempting pain will either
block input to the dorsal horn neurons of the spinal cord, where
central sensitization or hypersensitization (or wind-up) occurs, or
will decrease the responsiveness of the dorsal horn neurons
b. Multimodal analgesia should be used (especially when pain is moderate to
severe)
(1) Use of a variety of analgesic drugs, techniques, and routes of
administration, or multimodal analgesia
(2) The use of multimodal analgesia allows us to capitalize on the
additive or synergistic effects of analgesic drugs and allows us to
provide analgesia that is more intense and/or of longer duration
than analgesia provided with any one drug used alone
(3) This occurs because we affect the pain pathway at different sites
when we use different classes of drugs and we capitalize on specific
drug attributes
c. Analgesia should continue as long as pain is present or at least until pain
can be reasonably tolerated
(1) Many veterinarians feel that animals do not need analgesic drugs
once they have left the hospital because the patients tend not to
exhibit pain at home
(2) We know that animals instinctively hide pain and that pain, even
from elective procedures, is not magically eliminated once the
animal is no longer in the hospital
 (3) Instead, the pain dissipates gradually over a period of days to
weeks (depending on the severity of the disease, injury, or surgery),
and the pain that the animal experiences in that time should be
addressed
3. Analgesic techniques should be included in the perioperative plan
a. Preanesthesiause boluses of opioids, -agonists, and NSAIDs. Consider
2

starting a CRI for patients with moderate to severe pain. Preemptive

analgesia works
b. Maintenancewe can repeat boluses of opioids or -agonists, inject local
2

anesthetic drugs, and administer CRIs

(1) Analgesia in the maintenance period improves anesthetic safety by
allowing a decrease in the need for inhalant anesthetic drugs
c. Recoveryaddress pain
(1) We can use repeat boluses of opioids and/or -agonists
2

(2) May need to continue CRIs and consider nonpharmacological

therapy
(3) Prescribe drugs/techniques to be used after discharge from the
hospital
(4) Postoperative techniques that the owners can do at home include
icing incisions, simple flexion/extension exercises, and controlled
leash walking
(5) NSAIDs, tramadol, and other opioids such as codeine and fentanyl
patches are commonly used postoperatively
B. Medical
1. It is harder to use preemptive analgesia in patients that present already in pain, but
we can preempt a worsening of the pain by appropriate intervention
2. There are many causes of visceral pain, including pancreatitis; gastroenteritis; bowel
ischemia; inflammation; increased wall tension from distention of the GI tract, biliary
system, or urinary bladder; and capsular distention of solid organs
3. Regardless of the cause of the pain, failure to provide analgesia can increase
morbidity and even mortality
4. One of the best ways to provide analgesia for some of these medical conditions is
with CRI of an opioid, lidocaine, and ketamine
5. Multimodal
a. Local anesthetics that can be delivered by the epidural route or infused
intraperitoneally; or lidocaine can be delivered as a CRI
b. Ketamine would be a good choice when central sensitization will occur
because of the intensity of pain
C. Trauma
1. Pain stimulates the sympathetic nervous system; therefore, pain can contribute shock
2. Patients that receive adequate analgesia heal faster and experience fewer adverse
events than patients that do not receive adequate analgesia
3. Another point about trauma patients is that, just like surgical patients, patients with
pain from trauma that do not receive adequate analgesia are more likely to develop
persistent pain syndromes than those patients that do receive adequate analgesia
4. Assessment of pain should be part of the initial triage, not something we do when
we finally have a radiograph of the fracture
5. Pain adds to the patients demise
II. Chronic pain
A. Diseases that can lead to chronic pain development include OA, cancer, chronic otitis,
intervertebral disc disease, degloving injuries, and phantom limb pain
B. It is traditional to distinguish between malignant (related to cancer and its treatment) and
nonmalignant (e.g., neuropathic, musculoskeletal, inflammatory) chronic pain
C. Cancer patients tend to have more serious health restrictions and are prescribed more
opioids and other medications than patients with chronic nonmalignant pain
D. Nonmalignant chronic pain is frequently classified into inflammatory, musculoskeletal, and
neuropathic pain
E. The chief symptoms of neuropathic pain include spontaneous lancinating, shooting, or
burning pain; hyperalgesia; allodynia; or any combination of such pain
F. Cancer pain can originate from invasion of the tumor into tissues densely innervated by
primary afferent neurons (e.g., pleura, peritoneum) or directly into a peripheral nerve plexus,
with predominantly neuropathic symptoms
G. Management of chronic pain
1. A multimodal approach to pain management is more likely to achieve favorable
results
2. The hope is to attack more than one part of the pain pathway by treating the central
sensitization and wind-up
H. Hindrances to chronic pain management for animals include:
1. Lack of appreciation that many chronic disease processes and cancers are associated
with significant pain
2. Inability to assess chronic pain in dogs and cats
3. Lack of knowledge of drugs, drug therapy, and other pain-relieving techniques
4. Lack of communication with clients and lack of involvement of clients in the
assessment and treatment phases
5. Underuse of nursing staff for assessment
6. Reevaluation of pain in hospitalized patients
I. Chronic pain diseases
1. Osteoarthritis (OA)
a. Effective management of chronic pain such as that related to OA requires an
approach that impacts multiple points along the nociceptive pathway
b. Osteoarthritis can be either primary or secondary to underlying joint
pathology
c. It is characterized clinically by pain, deformity, and limited range of motion,
and is defined pathologically by focal erosive lesions, cartilage destruction,
subchondral sclerosis, and formation of large osteophytes at the joint
margins
d. The objectives of treatment for OA are multifaceted: reduce pain and
discomfort, decrease clinical signs, slow the progression of the disease,
promote the repair of damaged tissue, and improve the quality of life
e. Osteoarthritis is the most common orthopedic problem in dogs and cats,
encompassing about 20% of the population across all age ranges
f. The incidence increases with age
g. Multimodal therapy encompasses not only drugs that act at various levels of
the nociceptive pathways, but in the case of OA, multiple nondrug therapies
h. Therapies include:
(1) Weight loss
(2) Controlled exercise
(3) Analgesic drugs
 (4) Oral and injectable chondroprotective drugs
(5) Massage
(6) Acupuncture
(7) Therapeutic ultrasound
(8) Low-level laser therapy
(9) Physical rehabilitationcryotherapy, moist heat, passive range-of-
motion exercises, stretching exercises, balance and proprioception
exercises, electrical stimulation, active exercise (aquatic,
cardiovascular, muscular strength, endurance)
(10) Nutritional therapy
(11) Surgical interventiontotal hip replacement or orthopedic
procedures
(12) Regenerative stem cell therapy
(13) Platelet-rich plasma therapy
2. Neurological
a. Neurogenic pain (pain resulting from damage to the peripheral nerves or to
the CNS itself)
b. Symptoms associated with neurological pain
(1) Partial or complete loss of feeling
(2) Muscle weakness
(3) Partial or complete paralysis
(4) Changes in skin appearance and texture
(5) Muscle disuse atrophy
c. Conditions involving neurological pain
(1) Postamputation, spinal cord lesions, feline orofacial pain
syndrome, complex regional pain syndrome, feline interstitial
cystitis, equine laminitis, musculoskeletal disease, diabetic
neuropathy
d. Therapies include:
(1) Analgesic medications, including analgesic adjuvants
(2) Physical therapies
(3) Surgical intervention
3. Cancer
a. Cancers that induce osteolysis are most obviously painful processes
b. Intense cancer pain may be attributed to stretching of the capsule of certain
visceral organs, or to flow obstruction (biliary, urinary, or GI tracts)
c. The host's immune response to the cancer itself may generate pain as an
epiphenomenon through the liberation of inflammatory cytokines
d. The goal in managing dogs and cats with cancer is to control pain and
improve the patient's overall quality of life by using traditional anticancer
therapeutic modalities, various analgesic therapies, and supportive care
e. Some patients will benefit from palliative surgeries to remove painful
tumors, although the surgery itself may not positively affect the overall
prognosis for survival
f. Palliative care is any form of medical care or treatment that concentrates on
reducing the severity of disease symptoms, rather than striving to halt, delay,
or reverse progression of the disease itself or provide a cure
g. Multimodal therapy includes NSAIDs, opioids, local anesthetics, NMDA
antagonists, anticonvulsants, tricyclic antidepressants,
 aminobisphosphonates, and complementary therapies such as acupuncture
and rehabilitation medicine
h. Use caution when treating geriatric patients with a variety of agents, and
introduce new drugs one at a time, in a sequential manner
i. When side effects are encountered or if a drug is used at its maximum safe
dose without benefit to a patient, its use should be discontinued

PHARMACOLOGY OF PAIN MEDICATIONS

I. Opioids
A. Terminology
1. Opioidthis term describes any chemical that works by binding to opioid receptors
B. Opioid receptorsstill grouped into classes using Greek letters
1. Mu ()
2. Delta ()
3. Kappa ()
C. The analgesic effects of opioids are due to decreased perception of pain, decreased reaction
to pain, and increased pain tolerance
D. The side effects of opioids include sedation, respiratory depression, and constipation
E. Opioids may cause cough suppression, which can be an indication for opioid administration
or an unintended side effect
F. Classification of opioids
1. Agonista drug that binds to a receptor of a cell and triggers a response by the cell
a. Examples are morphine, hydromorphone, oxymorphone, fentanyl,
methadone, codeine, and meperidine
2. Partial agonista drug that binds to and activates a given receptor, but has only
partial efficacy at the receptor relative to a full agonist
a. Examples are buprenorphine, butorphanol, nalbuphine, and pentazocine
3. Antagonista drug that does not provoke a biological response itself upon binding
to a receptor, but blocks or dampens agonist-mediated responses
a. Examples are naloxone and naltrexone
4. Tramadol (Ultram, Tramal) is a centrally acting analgesic used for treating moderate
to moderately severe pain
a. Tramadol in dogs must be dosed more frequently than in cats
G. Doses are affected by:
1. Route of administrationsubcutaneous, intramuscular, intravenous, oral
2. Individual patient variationit is now apparent that individuals are unique with
respect to number, morphology, and distribution of opioid receptors and that these
differences are genetically determined
H. Medications
1. Morphine
a. Morphine has a duration of action of 4 to 6 hours
b. It stimulates volition, vagal and spinal cord reflex centers
c. It causes an increase in intraocular and intracranial pressure
d. It depresses respirations, cough reflexes, and vascular tone
e. It causes antidiuresis by stimulating release of antidiuretic hormone
2. Fentanyl
a. Fentanyl is a potent, short-acting, reversible narcotic that lasts 30 to 60
minutes
 b. It invokes exaggerated motor responses to loud noises (clapping, shouting)
c. It induces bradycardia in dogs and rabbits that is reversible with
anticholinergics
d. It induces respiratory depression, which may be offset when combined with
droperidol
e. It causes a decrease in intracranial pressure
f. Fentanyl can be purchased in different formulations, such as transdermal
patches, buccal tablets, and lozenges
3. Methadone
a. Methadone is a synthetic opioid, used medically as an analgesic, antitussive
b. Causes less histamine release than morphine
c. It has been used as a preanesthetic in dogs and cats
4. Oxymorphone
a. Oxymorphone is a semisynthetic narcotic analgesic with a potency 10 times
that of morphine
b. It cannot be used in horses
c. It has a duration of 4 to 6 hours and causes exaggerated motor responses to
noises
d. It does not have a marked respiratory depression
e. The cough reflex is not suppressed greatly
5. Hydromorphone
a. Hydromorphone is a Schedule II drug controlled by the Drug Enforcement
Agency in the United States; it is approximately 5 times as potent as
morphine on a milligram basis in humans and appears to have the same
potency as oxymorphone in dogs and cats
b. Hydromorphone was found to have antinociceptive effects in cats without
dysphoria or changes in behavior
c. It can be used with acepromazine or midazolam to provide greater sedation
when needed
6. Meperidine
a. Meperidine is a synthetic narcotic that is one tenth as potent as morphine
b. It is commonly used in dogs, cats, and horses
c. It has a duration of 2 to 3 hours and causes a decrease in intracranial
pressure
d. Primates are very sensitive to this drug
7. Butorphanol tartrate
a. Butorphanol is a synthetic analgesic with both narcotic agonist and
antagonist properties
b. The agonist activity is 3 to 5 times more potent than morphine and the
antagonist activity is equipotent with nalorphine and about one fiftieth as
potent as naloxone
c. Respiratory depression is similar to that of morphine but not dose related
d. It is a very effective cough suppressant
8. Buphrenorphine (injectable or transdermal patch)
a. Buphrenorphine is an opioid agonist-antagonist
b. It is almost 100 times more potent than morphine
c. The duration of action is 8 to 12 hours
d. It does cause respiratory depression and drowsiness
 e. It is frequently used because of the long duration of action, requiring only 2
daily doses
9. Pentazocine
a. Pentazocine has both agonist and antagonist activities
b. The agonist activity is about one third as potent as morphine
c. The duration of action is 2 hours
d. It mildly depresses respiratory centers and the cardiovascular system
e. Naloxone is the specific antagonist
10. Nalbuphine
a. Nalbuphine is a synthetic agonist-antagonist that reverses sedation but not
analgesia
b. It has agonistic properties equal to morphine
c. It can be given 15 to 30 minutes prior to recovery from anesthesia
d. The analgesic properties last 3 to 8 hours and have only minimal
cardiovascular and respiratory depression effects
11. Tramadol (oral and parenteral formulas)
a. Tramadol is one of the most prescribed centrally acting analgesics in the
world
b. The analgesic and antinociceptive potency is 5 to 10 times lower than that of
morphine
c. Onset time is 15 to 20 minutes
II. Nonsteroidal Antiinflammatory Drugs
A. The therapeutic benefits of NSAIDs include their antipyretic, analgesic, and
antiinflammatory actions
B. They exert these effects mostly through inhibiting the production of prostaglandins and
leukotrienes by the cyclooxygenase (COX) and 5-lipoxygenase enzymes, respectively
C. Two distinct COX isoforms (COX-1 and COX-2) have been identified as being responsible for
the production of prostaglandins
D. Both COX-1 and COX-2 are enzymes that are constitutively expressed (normally present in
tissues), as well as induced (appear or increase in concentration in response to an inciting
factor, often associated with inflammation)
E. COX-1 is considered as predominantly constitutive, being expressed in almost all tissues, and
involved in the production of prostaglandins responsible for housekeeping functions,
such as the cytoprotective effects in the gastric mucosa, normal platelet function, and
maintenance of renal perfusion
F. It appears that COX-2 has an important role in healing damaged mucosa in the GI tract
G. As a group, NSAIDs have a lower safety margin than opioids or -agonists and are not
2

reversible
H. Prostaglandins are important in mammalian renal physiology, where they play a role in
autoregulation of vascular tone, glomerular filtration rate (GFR), renin production, and
sodium and water balance
1. When renal hemodynamics are normal, prostaglandins appear to have a minimal
role
2. Under conditions of low effective renal blood flow, prostaglandins become crucial in
maintaining renal function and GFR; prostaglandin inhibition by NSAIDs may reduce
renal blood flow and GFR and can result in the potential complication of acute kidney
failure
I. Both COX-1 and COX-2 enzymes appear to be important in maintaining renal function, but
their relative importance and physiological role may differ between species
J. NSAIDs should be avoided in any animal when dehydration, hypovolemia, or hypotension
(hypoperfusion) exists or is anticipated
K. Pharmacology of NSAIDs
1. Despite widely varying half-lives of NSAIDs, most NSAIDs approved for dogs are
given once daily
2. Most NSAIDs persist in inflamed tissue longer than in plasma
a. NSAIDs are highly protein bound, and protein binding within inflamed
tissue may serve as a reservoir of the drug after it has been eliminated from
plasma
L. Medications
1. Acetaminophen
a. This drug must NEVER BE GIVEN TO CATS, but could be considered for
use in dogs
b. In dogs, it does produce analgesia even although it is not antiinflammatory
at clinically relevant doses
c. Acetaminophen is commercially available (but NOT approved for dogs by
the U.S. Food and Drug Administration) in combination with codeine,
oxycodone, and hydrocodone
d. Acetaminophen may act centrally at the COX-1 variant (previously referred
to as COX-3); this central action produces analgesia without affecting
prostaglandin synthesis at other (peripheral) sites
2. Carprofen
a. Carprofen is a unique modern NSAID that has limited COX inhibitory
action but retains potent analgesic and antiinflammatory properties
b. The exact mode of action of carprofen is not well understood
c. There is evidence from ex vivo studies in dogs that it is COX-2 selective
d. Alternatively, carprofen may have a significant effect on CNS COX activity
or perhaps on another isoenzyme
3. Meloxicam (injectable and oral syrup)
a. It is a relatively selective COX-2 inhibitor and is expected to be safer than
COX-1 inhibitors
b. A number of investigations into potential renal toxicity, particularly in
association with anesthesia during both hypo- and normotensive conditions,
have demonstrated its relative safety compared with COX-1 inhibitors
4. Ketoprofen
a. Ketoprofen is a potent COX and lipoxygenase inhibitor that provides good
postoperative analgesia and, in some circumstances, may even be superior to
opioids
b. Analgesia may also be superior to that of carprofen
c. However, as a potent COX inhibitor, caution must be taken with
preoperative use
5. Keterolac
a. Keterolac has been widely used off label in dogs and appears to provide
excellent postoperative analgesia for at least 24 hours
b. As with other NSAIDs, postoperative analgesia may be as good as and
perhaps better than that produced by butorphanol
c. As a potent COX inhibitor, it can cause renal damage and particularly gastric
ulceration, especially in hypotensive and hypovolemic patients
d. Keterolac is most safely given postoperatively
 e. Where another condition predisposing to gastric ulceration is relevant (e.g.,
recent corticosteroid treatment or trauma), sucralfate should be given (dogs,
0.5 to 1.0 gm; cats, 0.25 gm) orally before feeding
6. Deracoxib
a. Deracoxib is the first COX-2 (coxib)class NSAID in veterinary medicine
b. It is licensed in the United States for control of postoperative pain and
inflammation associated with orthopedic surgery and for the control of pain
and inflammation associated with OA
c. Deracoxib is available as a chewable tablet that has been shown to be
effective under both fed and fasted conditions
d. For postoperative orthopedic pain, deracoxib is administered orally prior to
surgery
7. Firocoxib (chewable tablet)
a. This drug also belongs to the coxib class
b. It is unique as there is no significant COX-1 inhibition at therapeutic dosages
8. Tepoxalin
a. Tepoxalin is an NSAID now available for use in dogs in Europe and the
United States
b. It is unique in being a dual-action NSAID, acting on both COX and
lipoxygenase
c. Tepoxalin appears to be effective and as well tolerated as any NSAID
9. Tolfenamic acid (Tolfedine)
a. Tolfedine is recommended for the alleviation of inflammation and pain
associated with OA in dogs with hip dysplasia, as an aid in the treatment of
upper respiratory diseases, and as symptomatic treatment of fever in cats
10. Robenacoxib
a. Robenacoxib tablets are indicated for the control of postoperative pain and
inflammation associated with orthopedic surgery, ovariohysterectomy, and
castration in cats 5.5 lb (2.5 kg) and 6 months of age; for up
to a maximum of 3 days
III. -Adrenoceptor agonists
2

A. They provide some effective analgesia; particularly effective in visceral pain in comparison to
somatic pain
B. When used during anesthesia, they reduce the dose of other anesthetics required
C. However, as analgesia is accompanied by sedation, in addition to all the other side effects,
their use for postoperative analgesia is not common
D. -Agonist and opioid combination shows marked synergism, and it is possible to obtain all
2

degrees of sedation and, in some cases, anesthesia with such combinations

E. No prepared combinations exist
F. They can provide effective analgesia with minimal side effects when used by the epidural
route
G. If antagonists have been used, analgesia is reversed alongside sedation
H. This group of sedative-analgesic drugs is not considered first line, but is commonly used as
analgesic adjuvants
I. At low doses, both sedation and analgesia are dose dependent
J. Effects
1. Reduce required dose of anesthetic and induction agents
2. Will cause vomiting in dogs and cats (rats and horses cannot vomit)
3. Increased urine output
 4. Animal is still arousable and is not anesthetized
5. Reflex bradycardia and bradyarrhythmias are common
6. Blood pressure and cardiac output may decrease
7. Avoid in animals with compromising cardiopulmonary disease
K. Tips
1. Routine use of anticholinergics is controversial due to the fact that the blood pressure
is already high and the bradycardia is a reflex response to adjust to the hemodynamic
effects
2. Administration of anticholinergics only because of bradycardia and not taking into
account the systemic blood pressure will cause further hypertension, particularly
pulmonary hypertension, and can lead to unwanted disastrous effects
3. If you have a patient in which an anticholinergic is needed, ideally, administer 15
minutes prior to administration of an -agonist
2

4. If you are combining dexmedetomidine with ketamine and buprenorphine, always

give the buprenorphine about 15 minutes prior to the other two drugs, as it has a
slower onset of action than other opioids
5. Always give oxygen for at least the first 10 minutes of recumbency after
administering dexmedetomidine
6. Try giving atipamezole subcutaneously instead of intramuscularly (intravenous
administration should be reserved for emergencies)the recoveries take a bit longer
but are very smooth and re-sedation is rare
L. Medications
1. Xylazine
a. Xylazine is a thiazine derivative that causes sedation, muscle relaxation, and
analgesia
b. It causes vomiting via direct central stimulation
c. It decreases minimum alveolar concentration for inhalation anesthetics by
40%
d. It causes hypotension and can induce a second-degree atrioventricular block
e. Yohimbine reverses the effects of xylazine
2. Dexmedetomidine
a. Dexmedetomidine is a highly selective and potent -adrenergic agonist
2

b. Peak sedation is during the first hour following administration, but dogs
receiving lower doses of dexmedetomidine will recover in shorter total time
c. Blood pressure increases and slowing of heart rate can be expected
following administration of dexmedetomidine
3. Romifidine
a. Romifidine is also a potent -adrenergic sedative-analgesic
2

b. It is being used in dogs and cats as premedication prior to both inhalant and
injectable anesthetics
c. Dosages mediating significant sedation and analgesia are associated with an
increase in vascular resistance, increased blood pressure, and slowing of
heart rate as with other -agonist medications
2

d. Lowering the dosage of romifidine reduces cardiovascular effects

e. Even though administration of an anticholinergic will prevent bradycardia,
neither significantly improves other cardiovascular indices
4. Detomidine
a. Duration of sedation longer than that of xylazine (twice), lasting at least 45
minutes
 b. Precautions are similar to those given for xylazine
c. Sedation of horse may be inadequate if the animal was excited before
administration of detomidine
IV. Anesthetic/analgesic reversal agents
A. Anesthetic reversal agents have been developed to displace anesthetic drugs that have a
specific receptor site
B. Their action can quickly restore the patient to its preanesthetic behavioral state
C. Medications
1. Flumazenil
a. Flumazenil is a benzodiazepine antagonist that blocks the CNS effects of
benzodiazepine agonists (diazepam or midazolam), including sedation,
impaired cognition, and anesthesia
b. It achieves maximum brain concentrations in about 8 minutes
c. It is not associated with any adverse cardiovascular effects
d. It is useful with its ability to rapidly reverse benzodiazepine
overdoseinduced coma
e. It is ineffective at reversing coma from barbiturates, polycyclic
antidepressants, phenothiazines, or alcohol
2. Yohimbine
a. Yohimbine has been used to antagonize the effects of the sedative-analgesic
xylazine
b. It is an indole alkaloid that is approximately 60 times more selective for -
2

than -adrenergic receptors

1

3. Atipamezole
a. Atipamezole is 200 to 300 times more selective for both and receptors
2 1

than yohimbine
b. It is superior to other clinically available compounds
c. Severe hypotension and tachycardia can occur following rapid intravenous
injection
d. This can be prevented by giving the agent intramuscularly or very slowly
intravenously
e. Dosages are specific for amounts of -agonist administered
2

f. Atipamezole is produced at a strength that is 5 times more potent than

dexmedetomidine; however, the manufacturer has formulated it so that the
same milliliter dosage is given to reverse the effects of the agonist
4. Nalorphine
a. Nalorphine is a morphine derivative that has one tenth to one thirtieth the
antagonistic activity of naloxone
b. It antagonizes the respiratory depressant effects of morphine
5. Naloxone
a. Naloxone is a pure antagonist
b. The half-life is shorter than those of some narcotics, and therefore the
dosage may need to be repeated
c. It reverses respiratory depression and analgesia of oxymorphone, fentanyl,
morphine, and meperidine
V. N-methyl-D-asparate receptor (NMDA) antagonists
A. Ketamine
1. Ketamine tends to provide better somatic analgesia than visceral analgesia
 2. CRI is now commonly used in some severely painful animals, particularly in the
intensive care unit setting, but usually is combined with other analgesics and
sedatives to enhance the analgesic efficacy and reduce dissociative side effects
(balanced analgesia)
3. Ketamine microdoses are used as an adjuvant to analgesia protocols
4. Ketamine preserves sympathetic reflexes and supports blood pressure
5. If there is a concern about wind-up and central sensitization, then an NMDA
antagonist is what is needed
6. Subanesthetic ketamine CRI appears to be protective against hyperalgesia and central
hypersensitization in the postoperative setting
7. The evidence is strong that ketamine CRI at subanesthetic doses is safe, is anesthetic
sparing, improves anesthetic cardiovascular and respiratory parameters, improves
analgesic effects of other drugs, helps prevent exaggerated and sustained pain states;
it is also inexpensive
VI. Local anesthetics (sodium channel blockers)
A. Sodium channel blockers are agents that impair conduction of sodium ions (Na ) through+

sodium channels
B. These drugs can relieve chronic neuropathic pain with a high therapeutic index
C. Intravenous lidocaine and lidocaine patches have both been shown to be efficacious for the
treatment of neuropathic pain in people
1. Intravenous lidocaine has been shown to relieve neuropathic pain in rats and people
for 3 to 21 days
D. Mexiletine may also be of use in patients experiencing refractory pain
E. Epinephrine elicits local vasoconstriction, which will keep the local anesthetic present for an
extended period of time, perhaps 3 to 4 hours for lidocaine
F. Probably the number 1 adverse effect of most local anesthetics is that they sting!
G. Medications
1. Lidocaine infusion
2. Lidocaine patch (Lidoderm)
a. The lidocaine patch produces concentrations far below those capable of
producing toxicity, but high enough to produce clinically effective local
analgesia for periods up to 24 hours without complete sensory block
b. Patches have been used to provide analgesia for skin abrasions, lacerations,
and severe local skin irritations (hot spots)
c. It is excellent for incisional pain and may be cut into smaller sizes than the
10 14-cm adhesive bandage
3. Mexiletine
4. Amino-ester local anesthetics
a. Procaine HCl, tetracaine HCl, benzocaine, proparacaine HCl
5. Amino-amide local anesthetics
a. Lidocaine HCl
b. Lidocaine has utility in almost any application where a local anesthetic of
intermediate duration is needed
c. It is also an antiarrhythmic agent
6. Prilocaine HCl
a. Eutectic mixture of local anesthetics (lidocaine and prilocaine), or EMLA
cream, produces anesthesia to a maximum depth of 5 mm and is applied
on the skin under an occlusive dressing that is left in place for at least 1 hour
b. It should not be used on mucous membranes or abraded skin
 7. Mepivacaine HCl
8. Bupivacaine HCl
a. Bupivacaine is a potent agent capable of producing prolonged topical
anesthesia
b. It provides more sensory than motor block
c. It is excellent when used with indwelling catheters and continuous infusion
pumps
d. It provides immediate postanesthetic analgesia for 180 to 600 minutes
e. All surgical layers need to be infiltrated
f. It can be used as 0.25% for infiltration, 0.5% for nerve block, or 0.75% for
epidural
g. It should not be injected into tissues that supply end arteries (ears or tails) or
very thin skin
h. The addition of epinephrine extends the duration of sensory anesthesia
VII. Adjunct medications
A. Nutraceuticals
1. Nutraceutical, a term combining the words nutrition and
pharmaceutical, is a food or food product that provides health and medical
benefits, including the prevention and treatment of disease
2. Such products may range from isolated nutrients, dietary supplements, and specific
diets to genetically engineered foods, herbal products, and processed foods such as
cereals, soups, and beverages
3. Some supplements that have been used to treat the chronic condition OA
a. Glucosamine
b. Chondroitin sulfate
c. Glucosamine + chondroitin sulfate
d. Methylsulfonylmethane (MSM)
e. Avocado/soybean unsaponifiables
f. Phycocyanin (PhyCox)
g. Eicosapentaenoic acid
h. Essential fatty acidsomega-3 fatty acids
i. Mictolactin (Duralactin)
j. S-adenosylmethionine (SAMe)
k. Perna canaliculusgreen-lipped mussel preparation
l. Elk antler
4. Other products
a. Hyaluronic acid (Legend)
b. Polysulfated glycosaminoglycan (Adequan)
(1) Do not use with NSAIDs that exhibit strong antithromboxane
(COX-1) activity
B. Selective serotonin/norepinephrine reuptake inhibitors (SSNRIs) and tricyclic
antidepressants (TCAs)
1. Serotonin and norepinephrine are both ligands that bind to receptors on the
presynaptic and postsynaptic membranes
2. Both ligands can bind to multiple receptors, and their effect on pain is related, in
part, to which receptors are bound (either ligand can be pronociceptive or
antinociceptive)
3. Serotonin and norepinephrine are both major players (along with enkephalins) in
descending inhibition from the brainstem
 4. Like it or not, using drugs in this classification always amounts to trial and error
5. Medications
a. Clomipramine, fluoxetine, and paroxetine
b. Amitriptyline
(1) Amitriptyline is the gold standard for analgesic antidepressants
(2) This drug has the best documented efficacy in the treatment of
neuropathic and nonneuropathic pain syndromes
(3) Amitriptylines analgesic mechanism of action has been
ascribed to decreasing reuptake of serotonin and norepinephrine at
either spinal terminals or the brainstem
(4) It also has antihistamine effects
(5) It has been used for idiopathic feline lower urinary tract disease
pain and possibly other chronic pain syndromes
(6) It should be noted that a condition known as serotonin syndrome
can develop if an animal is given a combination of an opioid with
TCAs (tricyclic antidepressants), SSRIs (serotonin-specific reuptake
inhibitor), or MAO inihibitors (monoamine oxidase). (i.e.,
Ttramadol + amitriptyline)
(a) It presents as mental status changes, autonomic
hyperactivity, and neuromuscular abnormalities
(b) If it occurs, it can be controlled by removal of the offending
drug combination and supportive therapy
(7) Amitriptyline has been tried to reduce feather plucking in birds
c. Trazodone
(1) Trazodone, which is a serotonin 2A receptor antagonist, is a mild
reuptake inhibitor
(2) A mixed SSNRI, trazodone has rapidly acting pharmacokinetics in
humans, and is a very sedating drug
(3) It is often used as a sleep aid in people, and has found a niche in
the behavior modification spectrum in dogs
(4) This drug is gaining popularity as an add-on for anxiety disorders,
and has not been studied in the context of pain in dogs and cats
C. Antiepileptic drugs
1. It is not hard to visualize why seizures, which are frequently characterized by
overactivity in a subset of neurons, could be related physiologically to chronic pain
states, which are also characterized by overactivity in a set of neurons
2. Increased activity changes synaptic connections, and modifies the subtypes of ion
channels being expressed
3. Some of the ion channels that are gradually modified include calcium channels and
sodium channels
4. Medications
a. Gabapentin, pregabalin, and lamotrigine
D. Bisphosphonates
1. Bony metastases are one of the most common causes of pain in advanced cancer
2. Some tumors cause osteoblastic metastases, but most cause osteolytic lesions
3. Bisphosphonates accumulate on bone surfaces and inhibit osteoclast-induced
resorption, favoring bone formation
4. This therapy may be expensive but has been shown to be useful in patients with
osteosarcoma-related pain
 5. Medications
a. Alendronate is a bisphosphonate drug used for osteoporosis and several
other bone diseases
(1) It should not be used in patients with severe kidney disease
c. Pamidronate
E. Tranquilizers (phenothiazines, benzodiazepines)
1. Tranquilizers alter an animals response to pain and can relax muscles; used in
combination with true analgesics
2. These drugs also reduce anxiety and fear, both of which which can exacerbate pain
F. Corticosteroids (prednisolone)
1. Corticosteroids have powerful antiinflammatory and immunosuppressive effects,
dampening the fires of acute inflammation

ANALGESIC TECHNIQUES
Administering analgesics encompasses a variety of techniques. Experienced veterinary technicians are able to
deliver drugs by oral, transmucosal, subcutaneous, intramuscular, intravenous, transcutaneous, and epidural
routes and by CRI.
I. Local anesthesia/analgesia
A. Local anesthesia falls into several categories: topical, infiltration, field blocks, selected nerve
blocks, spinal, and epidural anesthesia
B. Epinephrine (1:200,000) is often added to local anesthetics to produce vasoconstriction that
reduces absorption rates and maintains higher drug concentrations at the nerve fiber
C. This technique is useful for small mass removal, digit amputation, arterial catheter
placement, thoracocentesis, abdominocentesis, and bone marrow sampling
1. Local blockade permits reduction of general anesthetic requirements, which is
inherently safer for patients
2. Local anesthesia to a surgical site permits comfortable awakening from anesthesia,
with little potential for unwanted effects of systemic opioids, such as sedation or
respiratory depression
3. Local anesthetics are newly recognized to have many beneficial effects beyond
blocking nerve conduction
a. These include broad antiinflammatory effects (reduced production of
eicosanoids, thromboxane, leukotriene, histamine, and inflammatory
cytokines; and scavenging of oxygen free radicals) and antibacterial,
antifungal, and antiviral effects
4. Local anesthetics exert their action by binding to a hydrophilic site within sodium
channels, thereby blocking the channels and disallowing the Na influx; neurons then
+

may not depolarize and thus the effect can be complete anesthesia to a site rather than
mere analgesia
II. Topical
A. Application of topical analgesia to the surface skin or mucosa can reduce pain associated
with minor procedures, such as wound suturing, venipuncture, arterial puncture, nasal
cannulization, and urinary catheterization
B. Twenty to 30 minutes of direct contact time is required to ensure effective analgesia
1. Cocaine is currently used to provide topical anesthesia of the upper respiratory tract
a. Its vasoconstrictor and local anesthetic properties provide anesthesia and
shrinking of the mucosa with a single agent
2. EMLA cream (2.5% lidocaine 2.5% prilocaine)
 3. Lidocaine transdermal patch (Lidoderm)
III. Infiltration
A. Infiltration anesthesia is the injection of local anesthetics directly into tissue without taking
into consideration the pattern of cutaneous nerves
B. This technique is useful for small mass removal, digit amputation, arterial catheter
placement, thoracocentesis, abdominocentesis, and bone marrow sampling
1. Lidocaine (Xylocaine)
2. Bupivacaine
IV. Intravenous regional anesthesia/analgesia (see Web Fig. 22-2)
A. Intravenous regional anesthesia (IVRA), also called a Bier block after the physician who
developed the technique 100 years ago, can anesthetize the entire distal aspect of a limb
1. Blood is massaged proximally to a level above the cephalic or saphenous vein, where
a tourniquet is placed tightly enough to occlude venous but not arterial blood flow
2. The local anesthetic used in this case can only be lidocaine, without epinephrine, and
is injected intravenously below the catheter (some clinicians preplace an intravenous
catheter through which to inject; some do not)
3. Within 10 to 15 minutes, the region distal to the tourniquet will be rendered
anesthetized
4. The patient still requires general anesthesia, and the maximum time the tourniquet
should remain is 90 minutes
5. A tourniquet is placed on the affected limb after the leg is desanguinated with an
Esmarch bandage
6. The tourniquet should be applied with enough pressure to overcome arterial
pressure
7. Sensation to the limb returns in about 5 to 15 minutes after the tourniquet is
removed, and analgesia lasts about 30 minutes
8. May be a suitable technique for cats undergoing surgery of the distal limb (though
many recommend, out of an abundance of caution, limiting the lidocaine dose to
1 mg/kg and increasing the volume with saline)
WEB FIGURE 22-2 Bier block. (From Thomas JA, Lerche P: Anesthesia and analgesia for veterinary technicians, ed 4, St Louis, Elsevier Mosby, 2010.)

V. Regional anesthesia/analgesia nerve block

A. Nerve block anesthesia involves peripheral nerves or nerve plexuses
B. Blockade of these nerves usually anesthetizes somatic motor nerves, producing skeletal
muscle relaxation
C. The anesthetic is never injected into the nerve because this is painful and could result in
nerve damage; instead, it is deposited as close to the nerve as possible
D. The choice of anesthetic, as well as amount and concentration administered, is determined
by the nerves and the types of fibers to be blocked, the duration of anesthesia required, and
the size and health of the patient
E. All the blocks must be performed aseptically (aseptical preparation of the skin, sterile
dressing, and gloves)
1. Radial-ulnar-median nerve block and ring block (Figure 22-2)
a. This block is useful for procedures of the distal forelimb, such as two-foot
onychectomy or tenectomy, repair of torn toenails, or digit amputation
b. The superficial branches of the radial nerve and median nerve, and the
dorsal and ventral branches of the ulnar nerve, can be blocked distally by
placing 0.1 to 0.3 mL of local anesthetic at each of three locations
c. The median and palmar branch of the ulnar nerve are blocked on either side
of the accessory carpal pad on the caudal aspect of the carpus, and the
superficial branches of the radial nerve are blocked on the dorsal carpus, just
proximomedial to the dewclaw
d. As a supplement to this block, place an intradermal or subcutaneous wheal
at each joint along an imaginary line where each digit separates at the
metacarpophalangeal joint level
e. Bending each individual digit during the injection can facilitate
visualization of each metacarpophalangeal joint
 f. This technique may also be employed for hind limb onychectomy
g. Drugs most commonly used for radial-ulnar-median nerve blocks and ring
blocks include a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine
(1) Doses of 2 mg/kg should not be exceeded
h. Do not perform radial-ulnar-median nerve blocks and ring blocks in the
presence of infection at the injection site
i. Recovering patients should be observed

FIGURE 22-2 Circumferential block for feline declawing. The landmarks are shown indicating proper site for subcutaneous
injection of local anesthetic to provide block of the three major nerves in the feline forelimb. (From Bassert JM, Thomas J: McCurnin's

clinical textbook for veterinary technicians, ed 8, St Louis, Elsevier Saunders, 2013.)

2. Intercostal and interpleural nerve blocks
a. Indications for intercostal nerve blocks include rib fractures, post-
thoracotomy, or for pleural drainage
b. Intercostal nerve blocks eradicate input from and paralyze tissues
innervated by the intercostal nerves located between each rib, all without
respiratory depression
c. A minimum of three consecutive ribs must be blocked to provide analgesia
d. The intercostal nerves and vessels lie adjacent to the caudal border of each
rib
e. Bupivacaine (up to 2 mg/kg) is preferred because of its prolonged
duration of action (4 to 6 hours)
f. Intercostal blocks are not recommended for dogs with pulmonary diseases
that impair blood gas exchange, or for those patients who cannot be
observed for several hours postinjection, as there is the potential for
clinically delayed pneumothorax
g. Interpleural blocks offer an alternative to intercostal blocks after sternotomy
or thoracotomy
 h. Interpleural blocks may also be beneficial for relief of pain due to
pancreatitis, cholecystectomy, mastectomy, nephrectomy, and other cranial
abdominal procedures, as nerves innervating the cranial abdomen enter the
spinal cord in the caudal thoracic area
i. Intercostal nerves lie near the parietal pleura (the smooth lining of the chest
cavity), and local anesthetics diffuse across the pleura to block the intercostal
nerves
j. Bupivacaine (1.5 mg/kg) is commonly used because of its longer duration
of action (up to 8 hours), and is mixed with 3 parts by volume of 0.9% NaCl
to provide periodic (every 4 hours) analgesic doses through a surgically
placed thoracostomy tube
k. Ensure the patient is awake prior to administration of interpleural
bupivacaine, as catecholamine-induced arrhythmias may result secondary to
the instillation of cold and irritating substances
l. Alternatively, lidocaine (1.5 mg/kg) can be used prior to the injection of
bupivacaine
m. Lidocaine can still cause brief vocalization, but provides a more rapid onset
over bupivacaine
n. Distribution of this block can be affected by gravity, typically requiring the
patient to lie on the dependent side for 20 minutes postinjection for the block
to become effective
o. Do not exceed a total daily dose of 9 mg/kg of the bupivacaine
p. Pneumothorax is a potential complication of performing interpleural
regional anesthesia
3. Intraperitoneal block
a. Lidocaine can be used safely intraperitoneally post-ovariohysterectomy
(8 mg/kg with epinephrine 1:400,000 intraperitoneally, and 2 mg/kg
with epinephrine 1:200,000 incisionally) without signs of systemic lidocaine
intoxication
b. Bupivacaine (0.3 mL of a 0.5% solution) can be used to decrease the pain
and inflammation associated with certain abdominal conditions (e.g.,
pancreatitis)
4. Intraarticular block
a. Intraarticular injections of opioids and local anesthetics can provide
excellent analgesia postoperatively (e.g., poststifle surgery)
b. Bupivacaine (up to 3 mg/kg) is used most frequently and provides ~ 4 to
6 hours of local analgesia
c. It is injected in volumes large enough to fill the joint capsule after closure
has been completed
d. The intraarticular use of preservative-free morphine (0.1 to 0.3 mg/kg) can
provide analgesia that is equivalent to epidural morphine
e. Opioids appear to be most effective in chronically inflamed joints
5. Brachial plexus block
a. Brachial plexus blocks are relatively safe and easy to perform, and are
suitable for forelimb procedures distal to the elbow
b. Indications for this block include fractures of the radius and ulna, surgery of
the foot, and forelimb or digit amputations
c. A combination of 2% lidocaine and 0.5% bupivacaine may be used, at a
dosage of 1 mL/4.5 kg each
 d. Once the area is clipped and prepped, the patient's neck is placed in a
natural position so as to form a line with the cervical transverse process that
will traverse the proximal brachial plexus
e. Guide the needle beneath the scapula proximal to the shoulder joint (and
outside of the thorax) until the needle tip is caudal to the first rib
f. Aspirate to ensure proper placement of the needle outside of a blood vessel,
then inject 1- to 2-mL increments of the prepared mixture as the needle is
slowly withdrawn 1 cm at a time, until the needle is just ready to exit the
skin
g. Repeat this procedure if additional agent remains in the syringe after the
initial injection
h. Effectiveness of this block is difficult to assess without a nerve stimulator
i. Avoid this block in tissues located near infected areas
6. Dental blocks
a. Rostral maxillary (infraorbital) regional block
(1) The rostral maxillary block provides infiltration of the
lidocaine/bupivacaine combination adjacent to the infraorbital
nerve and the rostral maxillary alveolar nerve within the infraorbital
canal
(2) The latter leaves the inferior alveolar nerve within the canal to
enter the incisivomaxillary foramen to innervate the canine and
incisor teeth
(3) In addition, the first three premolar teeth as well as the maxillary
bone and surrounding soft tissue are affected
(4) To perform this block, retract the lip dorsally
(5) Palpate the infraorbital neurovascular bundle beneath the
vestibular mucosa
(a) This is a large cylindrical band that exits the infraorbital
canal dorsal to the distal root of the maxillary third premolar
(6) The thumb of one hand can be used to retract the bundle dorsally
(7) With the opposite hand, the needle is advanced close to the
maxillary bone ventral to the retracted bundle in a rostral-to-caudal
direction to a point just inside the canal
(8) The needle should pass without engaging bone
(9) If bone is encountered, the needle is withdrawn slightly and
redirected until it passes resistance free into the canal
(10) Proper insertion can be confirmed by gentle lateral movement of
the syringe, whereby the needle will meet resistance with the lateral
canal wall
b. Caudal maxillary (maxillary) regional block
(1) The caudal maxillary block allows infiltration of the local
anesthetic combination adjacent to the infraorbital nerve and the
pterygopalatine nerve caudal to the second maxillary molar
(2) These nerves are branches of the maxillary nerve that supply
sensory innervation to the maxilla
(3) In addition to the structures affected by the infraorbital block, it
will anesthetize the caudal cheek teeth and associated bone and soft
tissue
 (4) The soft palatal mucosa and hard palatal mucosa and bone will
also be affected by this block
(5) To perform this block, the mouth is opened wide and the lips are
retracted caudally at the lateral commissure
(6) The needle is directed dorsally immediately behind the central
portion of the maxillary second molar tooth
(7) Advancement of the needle need not be more than 2 to 4 mm
depending upon patient size
c. Rostral mandibular (mental) regional block
(1) The rostral mandibular block infiltrates the rostral extent of the
inferior alveolar nerve just before it exits the middle mental foramen
(2) The structures anesthetized include the incisors, the canine, and
the first three premolars
(3) The adjacent bone and soft tissue are also affected
(4) The middle mental foramen is located about one third of the
distance from the ventral border to the dorsal border of the
mandible at the level of the mesial root of the second premolar
(5) The landmark for infiltration is the mandibular labial frenulum
(6) The frenulum is retracted ventrally
(7) The needle is inserted at the rostral aspect of the frenulum and
advanced along the mandibular bone to just enter the canal
(8) If bone is encountered, the needle should be backed out and
redirected until the needle passes freely into the foramen
(9) Placement can be confirmed by moving the syringe laterally to
encounter the lateral aspect of the canal
(10) The patient's jaw, rather than the alveolar mucosa, will move
slightly if the needle is within the canal
d. Caudal mandibular (inferior alveolar) regional block
(1) The caudal mandibular block is performed by infiltrating the
inferior alveolar nerve prior to its entry into the mandibular foramen
on the lingual aspect of the caudal mandibular body
(2) The lateral canthus of the eye is the landmark for this block
(3) An imaginary plumb line is drawn from the lateral canthus of the
eye directly to the ventral mandible
(4) The needle is inserted into the skin at the lingual aspect of the
ventral mandible at this point
(5) The needle is advanced along the bone following the imaginary
plumb line to a point one third of the distance from the ventral to
the dorsal mandible
(6) The needle will now be in the vicinity of the mandibular foramen,
where the inferior alveolar nerve enters the mandibular canal
(7) It is not critical to be exactly at the foramen
(8) Radiographic dye studies indicate that the agent diffuses to
encompass a large area around the point of infusion
(9) This technique blocks all of the teeth of the mandible on the side of
infiltration as well as the adjacent bone and soft tissue
(10) Although very uncommon, patients receiving a caudal mandibular
nerve block have been known to traumatize their tongues by
mastication in the postoperative period
 (11) Observation and proper recovery assistance during this period will
eliminate this complication
7. Intratesticular block
a. Intratesticular injections have long been used for large animals, with good
evidence to support the technique, and have become popular for canine and
feline orchiectomy
b. When utilizing this technique, a 25-gauge needle is recommended with firm
and several-second aspiration to ensure that one has not inadvertently
entered a blood vessel
c. The volume of local anesthetic to inject should be enough to make the
testicle turgid, not a large amount
d. The proof of efficacy will be the lack of cremaster twitch when the clamps
are applied to the spermatic cord and associated structures
e. Place the needle through the testicle starting from the caudal pole and
aiming for the spermatic cord
f. It is acceptable, even desirable, for the needle to exit the testicle proximally
as it is the spermatic cord that will receive the direct clamp stimulation
g. ASPIRATE BEFORE INJECTING
h. Inject, expecting firm backpressure, while withdrawing the needle
i. Repeat for the other testicle
j. The leftover drug can/should be used to place a dermal incisional block
k. The total time for this procedure should be 1 to 2 minutes
VI. Epidural anesthesia
A. Epidural anesthesia is given by injecting local anesthetic into the epidural space (between the
ligamentum flavum and the dura)
B. Continuous infusion or bolus administration may be used
C. The local anesthetics act on the spinal nerve roots
D. Performance of epidural anesthesia requires a greater degree of skill than does spinal
anesthesia
E. Complete sterile technique MUST be used
1. Perform epidural injections in heavily sedated or anesthetized animals
2. The injection site is usually at the lumbosacral space in dogs and cats and can be
performed with the patient in either sternal or lateral recumbency
3. Epidural injection is easier to achieve with the patient in sternal recumbency, with
the hind limbs flexed at the hips and stifles and hocks extended so the legs are
positioned alongside the body
4. This position makes the lumbosacral space easier to identify
5. This technique is useful for pelvic and hind limb orthopedic procedures, perineal
and anal surgeries, exploratory laparotomy, and cesarean section
6. In addition to complete anesthesia, at least some sympathetic and motor blockade is
produced with local anesthetics
7. Lidocaine, mepivacaine, and bupivacaine consistently cause motor blockade, while
motor blockade is less intense and of shorter duration with levobupivacaine and
ropivacaine
8. The duration of motor blockade is generally shorter than the duration of analgesia,
and depending on the procedure and local anesthetic chosen, motor function usually
returns by the time a patient recovers from anesthesia
9. The diameter of the lumbosacral epidural space is 2 to 4 mm in medium-sized dogs
and less than 3 mm in cats
 10. As the needle is advanced, a popping sensation will be felt as the skin is penetrated
and then a second pop as the needle penetrates the ligamentum flavum and enters
the epidural space
11. Advance the needle no farther since most of the blood vessels lie in the ventral part of
the spinal canal, and it is more likely that a vessel will be penetrated if the needle is
advanced too far
12. In cats, the spinal dura mater frequently extends to S1-S2, so it is more likely that the
dura and arachnoid will be punctured if the needle is advanced too deeply, entering
the subarachnoid space
13. Occasionally, you will see the tail twitch or hind limb movement as the epidural
space is entered, indicating the needle has contacted the cauda equina
14. In this case, the drug may be injected without redirecting the needle
VII. Local block for dehorning a goat (Figure 22-3)
A. In the goat, the horn and immediately surrounding skin can be anesthetized by
blocking the corneal branch of the lacrimal nerve
B. This nerve is anesthetized by injecting a local anesthetic (1 to 2 mL of 2% lidocaine 1.5 to
2 cm deep) adjacent to the caudal ridge of the base of the supraorbital process
C. The cornual branch of the intratrochlear nerve, which is located dorsomedial to the eye and
adjacent to the margin of the orbit, can be palpated in some animals
D. Local anesthetic (1 to 2 mL of 2% lidocaine) can be administered there about 1 cm deep
E. By anesthetizing both of these sites, good horn analgesia is attained
F. Lidocaine alone can provide 90 minutes to 2 hours of local anesthesia when used for corneal
nerve block and ring block around the base of the horn
G. Bupivacaine, with its longer lasting effect, will provide 4 hours of pain relief
H. Xylazine sometimes is administered in combination with lidocaine, which prolongs the
usual duration of analgesia for this agent to 3 hours
I. Adding systemic administration of an NSAID such as ketoprofen to the dehorning protocol,
along with local anesthetic with or without xylazine, has been shown to greatly improve
animal comfort with consequent production advantages
FIGURE 22-3 Locations for blocking the nerves supplying the horns in a goat. The number 1 indicates the location to block
the cornual branch of the zygomaticotemporal nerve, and the number 2 indicates the location to block the cornual branch of
the infratrochlear nerve. It is important to note that both nerves must be blocked in goats as opposed to cattle, in which only
the cornual branch of the zygomaticotemporal nerve supplies the horns. (From Bassert JM, Thomas, J: McCurnin's clinical textbook for veterinary

technicians, ed 8, St Louis, Elsevier Saunders, 2013.)

VIII. Constant rate infusions
A. CRIs of analgesic drugs are an excellent way to manage pain in both dogs and cats. A CRI of
analgesic agents has several advantages over multiple repeated injections for pain relief,
including:
1. A more stable plane of analgesia with less incidence of breakthrough pain (which
can be difficult to treat)
2. A lower drug dosage delivered at any given time, resulting in a lower incidence of
dose-related side effects
3. Greater control over drug administration (easy to change the dose)
 4. Decreased need for stimulation of resting patients to administer drugs
5. Decreased cost (when compared to technician time, needles and syringes required
for repeat injections)
B. CRIs are extremely easy to use and extremely beneficial to the patient
C. A variety of drugs can be used in the CRI, and drug choice should be based not only on what
is best for the patient (e.g., analgesic potency and safety) but also on what is best for the
hospital (e.g., comfort level with and availability of drugs)
D. Because calculating CRI dosages can be cumbersome, math is often the only limitation to
using these valuable tools
E. Thus, rather than calculating drug dosages for each CRI, a cheat sheet or computer
program is recommended
1. Generally, dosing tables or individualized spread sheets (e.g., there are very useful
spreadsheets available at multiple websites, such as www.vasg.org) should be used for
CRIs
2. These sheets greatly improve the speed at which CRIs can be initiated and greatly
decrease the chance of mathematical errors
F. However, CRI dosages can also be easily calculated (see Chapter 20)
G. CRI medications and combinations
1. Opioids
a. The opioid class of drugs includes some of the most potent analgesic drugs
available, and opioids should be considered for any patient experiencing
moderate to severe pain
b. Although opioids are generally sedating in dogs, they can cause excitement
in cats
c. Fortunately, the low dose of opioids delivered in a CRI rarely results in
sedation or excitement
d. However, if excitement does occur, a light dose of a sedative (e.g.,
acepromazine or dexmedetomidine) can be administered to the cat and the
CRI rate maintained (if excitement is mild) or reduced (if excitement is
moderate)
e. If sedation occurs, the dose of the CRI can be decreased. Fentanyl,
hydromorphone, morphine, and methadone are potent full-agonist opioids
that provide profound dose-related analgesia
f. These full agonists are the most commonly used opioids, but butorphanol,
an agonist-antagonist, has an advantage in that this drug is more likely to
provide sedation than excitement in cats
g. However, butorphanol provides only moderate analgesia and has a ceiling
effect for pain relief (i.e., a point is reached where higher dosages result in
more sedation but not more analgesia)
h. Thus, butorphanol is only appropriate for short-term mild to moderate pain
and should be used as part of a multimodal protocol rather than as a sole
agent
2. Lidocaine
a. Lidocaine can be administered systemically to provide analgesia, but its
mechanism of action when used systemically is not entirely clear
b. Proposed mechanisms include blockade of sodium channels or potassium
currents in the dorsal horn of the spinal cord and direct inhibition of
abnormal electrical charges from injured or inflamed peripheral nerves
 c. Lidocaine CRIs are extremely useful in dogs but are somewhat controversial
in cats
(1) Cats appear to be more sensitive to the lidocaine-induced side
effects than other species (a lower dose is recommended for cats)
(2) There is evidence that lidocaine may cause excessive
cardiovascular depression in anesthetized cats due to the interaction
between lidocaine and anesthetic agents
(3) Some argue that lidocaine CRI has been used successfully for
antiarrhythmic therapy in cats without undue cardiovascular
depression and should be appropriate for analgesia, especially since
the dose for analgesic therapy is actually on the low end of the dose
used for antiarrhythmic therapy
(4) Because of the uncertainty of lidocaine effects in cats, some
veterinarians feel that lidocaine CRI is not warranted in the cat at all,
while others feel that it is an appropriate means to treat pain,
especially in patients in which other options may be limited
(5) If lidocaine CRI is chosen, using low dosages in conscious cats (i.e.,
not under anesthesia) is recommended
d. Lidocaine CRIs are commonly used in dogs, especially in dogs with GI pain
(e.g., pain from exploratory laparotomy, gastric dilatationvolvulus,
pancreatitis, parvovirus)
3. Ketamine
a. Painful impulses cause NMDA receptors (among others) in the dorsal horn
of the spinal cord to depolarize, and prolonged depolarization of these
receptors can lead to an amplification of the pain stimulus, resulting in what
we commonly refer to as wind-up or hypersensitization
b. When this occurs, the patient may feel more pain than expected
(hyperalgesia) or even feel pain in response to a nonpainful stimulus
(allodynia)
c. By administering drugs that antagonize these receptors (e.g., ketamine), we
are able to alleviate this exaggerated response and make the pain easier to
control
d. Ketamine is the NMDA receptor antagonist most commonly used in
veterinary medicine, and NMDA receptor antagonist effects are achieved
when ketamine is used as a low-dose CRI
e. A single high-dose bolus of ketamine (e.g., like the anesthetic induction
dose) can serve as a loading dose for a CRI but is unlikely to provide
analgesia when used alone
f. Furthermore, the NMDA receptor antagonists strictly mediate
hypersensitivity and do not provide true analgesia; thus, these drugs must
be administered in conjunction with true analgesic drugs (e.g., opioids or
NSAIDs)
4. -Agonists
2

a. -Agonists provide both sedation and analgesia, and the effects are
2

reversible. Sedation is only minimal when using the CRI, but the light level
of sedation makes this CRI excellent for patients that are excited or
distressed
b. The -agonists are generally added to an opioid CRI (or any other CRI)
2

5. Combinations of opioids, ketamine, and (possibly) lidocaine

 a. CRIs that include multiple drugs are often more effective than CRIs of single
drugs because the effects of analgesic agents from different drug classes are
generally additive or synergistic
b. Combinations include opioids + ketamine or
opioids + ketamine + lidocaine
VIII. Diffusion catheter
A. In humans, the Soaker Catheter (Ethicon, Somerville, NJ) has a reservoir that gradually
discharges the local anesthetic into the catheter, bathing the tissue in the area into which it has
been applied
1. It has been used in subcutaneous, suprafascial, subfascial, intraarticular, peripleural,
and periosteal tissue
2. This technique has been shown to decrease systemic opioid consumption, improve
sleep patterns, speed recovery and discharge, and improve pain scores at rest and
with activity, and has become widely accepted as a powerful tool in the toolbox
B. In the veterinary literature, we have two studies, one involving amputation and the other in
total ear ablation
C. Anecdotally, diffusion catheters have found success in a wide variety of other applications in
veterinary medicine, many of them involving large soft tissue resections, trauma repair, and
open fracture repair
D. Theoretically, anywhere a catheter can reach is a candidate for this technique
E. The catheters are placed prior to closure in a manner to bathe the desired muscle, nerve, and
subcutaneous tissue, ensuring that no pores are exposed above the skin
F. The proximal end of the catheter exits dorsal to the wound area, secured to the skin in a
customary finger-trap manner, and covered with a dressing in a manner to prevent the patient
from removing it
G. There are two different ways to infuse the local anesthetic through the catheter
H. One common way is to inject bupivacaine morphine + saline to increase volume
depending on the area involved, every 6 hours
I. Also described are CRIs using either a fluid or syringe pump (lidocaine)
J. The catheters are usually kept in for 24 to 48 hours

NONPHARMACOLOGIC PAIN MANAGEMENT

I. Veterinary rehabilitation and its application in pain management
A. The three basic approaches to pain management in human physical therapy are manual
techniques, electrophysical agents (physical modalities), and interventions that change
movement patterns thought to promote pain
B. Veterinary rehabilitation is the application of an all-new diagnostic algorithm to our patients
C. It focuses upon soft tissues rather than bone and joints. It involves special tests that allow for
determination of specific tendinopathies and soft tissue abnormalities
D. The use of objective outcome measures, evaluated with goniometers and Gulick
girthometers, provides clear evidence of the progress of the patient during and after
rehabilitation therapies have been applied
E. The emphasis in rehabilitation therapy is on meeting goals that are functional for the patient
F. The goals of rehabilitation include the restoration, maintenance, and promotion of optimal
function and quality of life as they relate to movement disorders
G. The majority of rehabilitation therapeutics involve manual therapies and problem solving
rather than the use of toys
H. Examples of manual therapies include joint mobilizations, focusing on arthrokinematics
rather than osteokinematics; stretches, focusing upon flexibility and hypomobility; and
therapeutic exercises, progressing from concentric to eccentric contractions
I. Equipment used on a regular basis in veterinary rehabilitation includes physioballs, therapy
bands, rocker/wobble boards, cavaletti poles, and land treadmills
J. Hydrotherapy equipment can include pools, resistance pools, and underwater treadmills
K. Additional manual techniques applied to our veterinary patients include soft tissue massage
and soft tissue mobilization
L. Massage can decrease excessive tissue tension associated with activated mechanical
nociceptors and aid in removal of chemical substances in soft tissue that activate chemical
nociceptors
M. Soft tissue massage can also reduce pain by stimulating large, rapid conduction fibers,
selectively closing the gate against smaller pain fiber input
N. Massage techniques
1. Effleurage techniques can be used to diminish edema and enhance lymphatic flow,
thereby relieving pain associated with pressure, can increase circulation, and can
relieve muscle spasm
a. These are techniques that put pressure into the tissue and can be long or
short strokes, superficial or deep strokes, straight or circular strokes
2. Petrissage techniques are lifting, pulling, and broadening techniques that increase
circulation, stimulate the nervous system, mechanically relax muscles, and reduce
muscle stiffness
3. Friction massage affects nocioceptors to relieve pain, increases circulation, and aids
in reorganizing collagen
a. Friction massage can be used to decrease inflammation and break up fibrous
tissue in tendinopathies
b. Friction massage has contraindications that include using it immediately
postinjury (bruising or over an incision), over a hematoma, in conjunction
with a bleeding disorder, or if the patient is on anticoagulants
4. Tapotement, or tapping on the tissue, is also effective in pain modulation, likely as a
result of the gate theory
a. Tapotement massage can be used to coupage the lungs or to cause muscles
to fire and contract for strengthening
O. Physical modalities commonly used in human physical therapy, and now in veterinary
rehabilitation, include electrotherapy, electromagnetic fields, light, heat, sound, and water
1. Electrical stimulation can affect the sensory and the motor nerves
a. Indications for electrical stimulation include wound healing, pain
control/relief, reduction of edema
b. Transcutaneous electrical nerve stimulation (TENS)
(1) TENS works by applying a high-frequency current to the skin
c. Neuromuscular electrical stimulation (NMES)
(1) NMES works on motor nerves and impacts muscle fibers
(2) It is particularly useful in patients that cannot perform voluntary
movement, that have edema, or that have delayed wound healing
(3) In the patient that is able to stand, NMES can cause increased
muscle contraction during weight bearing, and in the ambulatory
patient, timed NMES can assist in muscle reeducation during
gaiting
2. Iontophoresis
 a. Iontophoresis is the transcutaneous delivery of medications via direct
current using electrostatic repulsion
3. Laser
a. Laser is light amplification by stimulated emission of radiation
b. By definition, a laser must be collimated and monochromatic
c. Penetration of laser energy is determined by the wavelength, and many
wavelengths are patented
d. The physiological effects of laser stimulation include accelerated cell
division via mitochondrial stimulation, increased leukocyte phagocytosis,
stimulation of fibroblast production, enhanced synthesis of adenosine
triphosphate, and angiogenesis
e. Treatment with laser is indicated for pain management, control of
inflammation, and tissue healing
4. Sound therapy
a. Ultrasound
(1) Therapeutic ultrasound converts electricity to sound waves by
means of a piezoelectric effect upon the crystal housed in the
transducer head
(2) Common uses for therapeutic ultrasound in veterinary
rehabilitation include heating areas of muscle spasm to create
relaxation, treating tendinopathies with nonthermal effects to break
up the debris within the tendon sheath, and stimulating the
insertion of the iliopsoas muscle to encourage healing of a strain
lesion
b. Extracorporeal shock wave therapy (ESWT)
(1) ESWT, also known as high-energy focused sound wave therapy, is a
newer modality in veterinary medicine
(2) ESWT has been applied to painful OA lesions in veterinary
practice, including hip and elbow dysplasia and supraspinatus
tendinopathy, with excellent pain relief results being reported
P. Thermotherapy
1. Heat can be applied by hot packs, infrared light, hydrotherapy, and therapeutic
ultrasound
Q. Cryotherapy
1. Cryotherapy can be applied via ice bath, ice massage, ice pack, vapocoolant gel, or
circulating ice compression units
2. The beneficial effects of cryotherapy include vasoconstriction; reduced cellular
metabolism, decreased nerve conduction velocity, and decreased production of pain
mediators, leading to analgesia; and reduction of edema and decreased muscle spasm
R. Therapeutic exercise
S. Weight management
T. Acupuncture
U. Myofascial trigger point therapy
1. The term myofascial trigger point refers to a pain phenomenon of soft tissue origin that
is characterized by two specific attributes: a hardened muscle band (motor
dysfunction) that is intensely painful on palpation (sensory dysfunction)

ACKNOWLEDGMENTS
The author wishes to acknowledge the International Veterinary Academy of Pain Management (IVAPM), and
especially Drs. Robin Downing, Mike Petty, Mark Epstein, Sheilah Robertson, Tammy Grubb, Bonnie Wright,
Janet Van Dyke, Laurie McCauley, and Rick Wall for their inspirational lectures.
Please visit http://evolve.elsevier.com/Tighe/Brown/ to view additional figures, tables, and boxes that
accompany this chapter.

REVIEW QUESTIONS
1. The veterinary technician can play an important role in pain management by:
a. Monitoring urine and fecal output
b. Changing the medication when it is ineffective
c. Communicating directly with the clinician about particular concerns
d. Directing the veterinary assistant to give medications

2. Name three signs of pain in a cat.

a. Sleeping continually, overeating, attention-seeking behavior
b. Resentment at being handled, aggression, abnormal posture
c. Hyperactivity, pupillary enlargement, tail swishing
d. Hypotension, hypocapnia, bradycardia

3. During hospitalization, how often should pain assessment be performed?

a. Every 4 to 6 hours
b. Every 30 minutes to 1 hour
c. Every 12 to 24 hours
d. Every 8 hours

4. When trying to distinguish pain from dysphoria

a. Put the patient on comfortable blankets
b. Speaking in low tones and interaction with the animal makes the patient feel better but behaviors
resume when interaction stops
c. Moving the animal to a different ward makes it better
d. Automatically reverse the analgesic medication

5. What guidelines have elevated pain to the Fourth Vital Sign?

a. American College of Veterinary Anesthesiologists' Pain Management Guidelines
b. The International Veterinary Academy of Pain Managements Guidelines
c. AAHA/AAFP Pain Management Guidelines for Dogs and Cats
d. The AVMA Pain Management Guidelines

6. What is nociception?
a. The activity in the peripheral pathway that transmits and processes the information about the
stimulus to the brain
b. A normal response to tissue damage
c. Pain without apparent biological value that has persisted beyond the normal tissue healing time,
usually taken to be 3 months
d. Any stimuli to the affected area that would normally be innocuous becomes noxious
7. What is the correct sequence of steps in the pain pathway?
a. Transduction, transmission, modulation, perception
b. Modulation, transduction, perception, transmission
c. Transduction, modulation, transmission, perception
d. Transmission, transduction, modulation, perception

8. What is wind-up?
a. An increase in the excitability of spinal neurons, mediated in part by the activation of NMDA
receptors in dorsal horn neurons
b. Occurs when tissue inflammation leads to the release of a complex array of chemical mediators,
resulting in reduced nociceptor thresholds
c. Brief trauma or noxious stimulusphysiological pain
d. The perceived increase in pain intensity over time when a given painful stimulus is delivered
repeatedly above a critical rate

9. An example of an opioid agonist is:

a. Butorphanol
b. Naloxone
c. Morphine
d. Buprenorphine

10. Prostaglandins play an important role in:

a. Production of endorphins
b. Mammalian cardiovascular physiology
c. Production of leukotrienes
d. Mammalian renal physiology

11. Which of the following is an NMDA antagonist medication?

a. Ketamine
b. Lidocaine
c. Meperidine
d. Dexmedetomidine

12. Gabapentin is a(n):

a. Benzodiazepine
b. Sodium channel blocker
c. Antiepileptic
d. Nutraceutical

13. An example of topical analgesia is:

a. Buprenorphine
b. EMLA cream
c. Bupivacaine
d. Fentanyl

14. An intratesticular block:

 a. Can only be used in large animal patients
b. Is an excellent block for canine and feline orchiectomy
c. Requires the use of a vaporizer
d. Has never been performed in veterinary patients

15. What is NOT a benefit of a constant rate infusion?

a. A more stable plane of analgesia with less incidence of breakthrough pain
b. Greater control over drug administration
c. A lower drug dosage delivered at any given time, resulting in a lower incidence of dose-related
side effects
d. Allows the technician to leave the room and come back several hours later

16. Massage is an example of what rehabilitation technique?

a. Manual therapy
b. Effleurage techniques
c. Physical modalities
d. Therapeutic exercise

17. What is a benefit of cryotherapy?

a. Decreased metabolism so patient is less hungry
b. Decreased production of pain mediators, leading to analgesia
c. Prevention of hyperthermia
d. Useful 2 to 3 weeks postinjury

18. What is a myofascial trigger point?

a. A point in the muscle where you elicit a reflex
b. A microlesion in the muscle
c. Painful areas of sustained muscle contraction that cannot easily self-release because of anoxia
d. A technique where needles are used to pierce the skin at certain points to bring about a
physiological change to treat or prevent disease

19. What is NOT a type of visceral pain?

a. Pancreatitis
b. Gastroenteritis
c. Bowel ischemia
d. Osteosarcoma

20. What are three chronic pain diseases?

a. Lymphoma, diabetes, gastric dilatationvolvulus
b. Osteoarthritis, intervertebral disc disease, cancer
c. Respiratory infection, cardiac disease, blocked cat
d. Broken leg, bronchitis, hypertension
CHAPTER 23

Surgical Principles
SURGICAL INSTRUMENTS
The veterinary technician should be familiar with basic surgical instruments, their components (Figure 23-1),
and their intended use. Instruments should only be used for their intended purpose as improper use can
destroy the instrument, costing the veterinary hospital considerable expense. The following are some common
instruments used in veterinary surgery.

FIGURE 23-1 Parts of surgical instruments. (From Bassert JM, McCurnin DM, editors: McCurnin's clinical textbook for veterinary technicians, ed 7, St Louis,

Elsevier Saunders, 2010.)

Scissors
I. Operating scissors are generally for cutting suture, drape material, or other inanimate material. They
are classified in three ways (Figure 23-2)
A. Type of point (e.g., blunt/blunt, sharp/blunt, or sharp/sharp)
1. Blunt scissors have a rounded edge
2. The most common operating scissors have the sharp/blunt point
B. Shape of the blade (e.g., straight or curved)
C. Cutting edge (e.g., plain or serrated)

FIGURE 23-2 Identifying operating scissors. Left to right, harp/sharp, sharp/blunt, blunt/blunt. (From Tear M: Small animal surgical nursing

skills and concepts, ed 2, St Louis, Elsevier Mosby, 2012.)

II. Mayo scissors work well for cutting and dissecting dense tissue
A. Tips are blunt
B. Blades can be straight or curved
III. Metzenbaum scissors have fine tips and long handles for cutting and dissecting more delicate tissue
A. Tips can be blunt or pointed
B. Blades can be straight or curved
IV. Iris scissors are small, sharp, delicate scissors commonly used for intraocular surgery
V. Wire-cutting scissors have short, thick jaws with serrated edges for cutting wire suture material
VI. Littauer and Spencer suture removal scissors are used to cut and remove sutures postoperatively
A. Have blunt tips with one blade terminating into a thin, curved hook
B. Spencer scissors are smaller than Littauer scissors
VII. Lister bandage scissors are used to cut under a bandage without puncturing the patients skin
(Figure 23-3)
A. One blade has a flat, thick edge and a blunt tip
B. Available in various sizes
FIGURE 23-3 Lister bandage scissors. (From Sonsthagen TF: Veterinary instruments and equipment: a pocket guide, ed 2, St Louis, Elsevier Mosby, 2011.)

Forceps
I. Thumb forceps are hand held in a pencil grip to hold tissue (see Web Fig. 23-1)

WEB FIGURE 23-1 Holding thumb forceps with a pencil grip. (From Fossum TW: Small animal surgery, ed 3, St Louis, Elsevier Mosby, 2007.)

A. Rat-tooth thumb forceps are used to grasp skin and are commonly used to place sutures
1. They have large teeth
2. The teeth intermesh (one tooth fits in between two teeth on the opposite tine when
closed)
 B. Adson tissue forceps provide good tissue grip with minimal damage to tissue because they
have very fine rat tooth tips. They are used on delicate tissues
C. Brown-Adson tissue forceps have multiple fine intermeshing teeth on edges of the tips
(Figure 23-4)
1. The sides of the blades are wider for ease of handling
2. They are also used with delicate tissue

FIGURE 23-4 Brown-Adson tissue forceps. (From Sonsthagen TF: Veterinary instruments and equipment: a pocket guide, ed 2, St Louis, Elsevier Mosby, 2011.)

D. Dressing forceps have serrations but no teeth on the jaws; they are useful for handling
dressing material
E. Russian tissue forceps have rounded tips and are used for holding hollow viscera
II. Self-retaining forceps use a ratchet-locking device to grasp and retract tissue
A. Allis tissue forceps have intermeshing teeth that ensure a secure grip, but they can cause
trauma to delicate tissue
B. Babcock intestinal forceps are similar to the Allis forceps, but have no gripping teeth, which
enables them to be used on delicate tissues
C. Doyen intestinal forceps are useful for holding bowel
D. Ferguson angiotribe forceps assist in holding large bundles of tissue
E. Sponge forceps have a hole in the center of its circular tips and hold gauze to provide
hemostasis during surgery or when performing patient preparation
F. Backhaus towel clamps are considered forceps and are used to secure drapes to the
patients skin
G. Roeder towel forceps are similar to the Backhaus towel forceps, but have a metal bead on
each tip that does not puncture the skin as deeply and helps keep the drape from sliding
H. Jones towel clamps have a squeeze handle mechanism and are lighter weight and more
delicate than other towel clamps
I. Lorna (Edna) nonpenetrating towel clamps are used to secure second-layer drapes to the
ground drapes (Figure 23-5)
FIGURE 23-5 Towel Clamps. Left to right, Roeder, Backhaus, Lorna, Jones (Photo by John T Miller. In Tear M: Small animal surgical nursing skills

and concepts, ed 2, St Louis, Elsevier, Mosby, 2012.)

III. Hemostatic forceps (commonly referred to as hemostats) can be straight or curved and are used for
ligating vessels and tissues
A. Halsted mosquito forceps control capillary bleeders
1. Length: up to 10 cm (4 inches)
2. Transverse serrations cover the entire jaw length
B. Kelly and Crile hemostatic forceps are used to grasp intermediate-size vessels
1. Standard length: 12.5 cm (4.5 inches)
2. Kelly forceps have distal transverse grooves
3. Crile forceps have complete transverse grooves (Figure 23-6)
FIGURE 23-6 Hemostatic forceps tips. Left to right, Halsted mosquito, Crile, Kelly. (Photo by John T. Miller. In Tear M: Small animal surgical

nursing skills and concepts, ed 2, St Louis, Elsevier Mosby, 2012.)

C. Rochester-Pean and Rochester-Carmalt forceps clamp large tissue bundles that contain blood
vessels; they are commonly used in stump and pedicle ligation
1. Larger forceps: 20 cm (9 inches)
2. Rochester-Carmalt forceps have longitudinal grooves and distal transverse grooves
3. Rochester-Pean forceps have transverse grooves (Figure 23-7)
FIGURE 23-7 Rochester-Pan forceps. (From Sonsthagen TF: Veterinary instruments and equipment: a pocket guide, ed 2, St Louis, Elsevier Mosby, 2011.)

D. Rochester-Ochsner forceps are similar to Rochester-Pean forceps, but in addition have 1:2
teeth at the tips (Figure 23-8)
1. The designation 1:2 means that one tip has one tooth and the other tip has two teeth,
and the teeth mesh when the tips are closed
2. The teeth allow the surgeon to get a better grip on larger tissue bundles

FIGURE 23-8 Rochester-Ochsner forceps. (From Sonsthagen TF: Veterinary instruments and equipment: a pocket guide, ed 2, St Louis, Elsevier Mosby, 2011.)
Needle Holders
I. Type of forceps used to hold suture needles and aid in tying sutures
II. The jaws are very short and have a roughened platform in the tips. They are the only surgical
instruments designed to hold metal
III. Surgeon preference determines the type of needle holder used
IV. Olsen-Hegar and Mayo-Hegar needle holders (Figure 23-9) are commonly used in veterinary surgery
A. Olsen-Hegar needle holders also have a scissors to cut sutures without using a separate
scissors
B. The Mayo-Hegar instrument can be used only as a needle holder (no scissors)
C. Crisscross grooves assist in grasping the needle

FIGURE 23-9 Needle holder tips. Left, Olsen-Hegar; right, Mayo-Hegar. (From Tear M: Small animal surgical nursing skills and concepts, ed 2, St
Louis, Elsevier Mosby, 2012.)

Retractors
I. Senn rake retractors are double-ended handheld retractors and useful for skin and superficial muscle
retraction (Figure 23-10)
A. One end has a three-pronged point (sharp or blunt) that curves
B. This end looks somewhat like a rake
FIGURE 23-10 Handheld retractors. Top to bottom: Senn, Army Navy, malleable, Hohmann. (From Fossum TW: Small animal surgery, ed 3,

St Louis, Elsevier Mosby, 2007.)

II. Meyerding, Hohmann, and Army Navy retractors are hand held for larger muscle masses
A. Army Navy retractors come in a set of two
B. An Army Navy retractor has one end shaped like a paddle so the wound edges can be
opened easily
III. Malleable retractors are made of a soft metal that can be bent to accommodate hard-to-retract areas
IV. Self-retaining retractors have a locking mechanism
A. Gelpi retractors have a single tip that extends outward to retract muscles; they are commonly
used during orthopedic procedures and neurosurgery
B. Weitlaner retractors are similar to Gelpi retractors but have multiple prongs at the tips; they
are also commonly used during orthopedic procedures and neurosurgery
C. Balfour retractors are useful in abdominal surgery to hold the abdomen open; several sizes
are available
D. Finochietto retractors are used during thoracic surgery
V. The ovariohysterectomy hook or spay hook is a type of retractor
A. The Snook spay hook has a broad, flat handle and a flat, curved tip (Figure 23-11)
FIGURE 23-11 Snook spay hook. (From Sonsthagen TF: Veterinary instruments and equipment: a pocket guide, ed 2, St Louis, Elsevier Mosby, 2011.)

B. The Covault spay hook has an octagonal handle and a buttoned tip

Common Orthopedic Instruments

I. Kern and Richards forceps have strong gripping teeth; some have a ratchet to manipulate bone
fractures to reduction
II. Verbrugge and reduction forceps can hold bone fragments in reduction while inserting fixators such
as screws
III. Wire twisters look like larger needle holders
IV. Jacobs chucks are used to advance pin placement
V. Rongeurs, such as the Lempert, are used to break up and remove bone
VI. Bone-cutting forceps, such as the Liston, are used to cut bone
A. They often have a double handle to increase power
B. They have smooth, heavy, scissor-like jaws
VII. Osteotomes are used to cut through bone
VIII. Mallets are used to strike an osteotome or any other instrument that needs to be pounded during
surgery
IX. Bone curettes have a sharp edge to remove bone
A. Usually has a cup shape on one end
B. Commonly used to scrape out osteochondritis dissecans (OCD) lesions
X. Bone rasps are used to smooth rough edges on bone
XI. Periosteal elevators, such as the Freer and Langbeck elevators, are used to remove muscle from bone
by releasing the periosteum
XII. Intramedullary pins, cerclage wire, Kirschner wire, and bone plates and screws are used to stabilize
fractures

Suction
I. Suction is used to remove fluid or air from an area
A. Manual suction can be performed using a syringe or bulb syringe
B. Mechanical suction utilizes a pump to remove air or fluid
1. Some units require a motor and electricity to generate a vacuum (see Web Fig. 23-2)
WEB FIGURE 23-2 Electrically powered, motorized suction machine. (From Tear M: Small animal surgical nursing skills and concepts, ed 2, St Louis,

Elsevier Mosby, 2012.)

2. Other units require a central vacuum system (see Web Fig. 23-3)
WEB FIGURE 23-3 Central vacuum, double-collection suction unit. (From Tear M: Small animal surgical nursing skills and concepts, ed 2, St Louis,

Elsevier Mosby, 2012.)

II. Suction tips (see Web Fig. 23-4)
A. Poole tips work well to remove abdominal fluid without being plugged by omentum
B. Frazier-Ferguson tips allow variable suction strength for removing blood
C. Yankauer tips are best for removing fluid other than blood
WEB FIGURE 23-4 Suction tips. Top to bottom: Poole, Yankauer, Frazier. (From Fossum TW: Small animal surgery, ed 3, St Louis, Elsevier Mosby,

2007.)

Scalpel Blades and Handles

I. Bard-Parker scalpel handle is used with a detachable blade
II. Use a needle holder to attach and remove the blade
III. A no. 3 handle and a no. 10, 11, 12, or 15 blade are most commonly used in small animal surgery
(Figure 23-12)
A. No. 10 is the basic blade and is commonly used for incising skin
B. No. 11 blade is used to sever ligaments
C. No. 12 blade is used to lance abscesses
D. No. 15 blade is used for precise, small or curved incisions
FIGURE 23-12 Scalpel blades. Left to right, no. 10, no. 11, no. 12, no. 15. (From Tear M: Small animal surgical nursing skills and concepts, ed 2, St

Louis, Elsevier Mosby, 2012.)

IV. A no. 4 handle and a no. 20 blade are most commonly used for large animal procedures

Electrosurgery
I. Electricity transmitted through a handpiece can be used to cut or coagulate vessels
II. Single and reusable hand pieces are available
III. Monopolar electrosurgery
A. When the handpiece is activated, the electrical current passes through the patient and must
be diverted away
B. A ground plate is placed in contact with the patient to divert the current
C. A sponge, saturated with water or saline, may be placed between the patient and the ground
plate to help maintain contact
D. Alcohol is never used on the sponge as it may cause burns or fire
IV. Bipolar electrosurgery
A. The handpiece utilized resembles thumb forceps
B. The current travels from one tip to the other, negating the need for a ground plate
V. Groove directors are sometimes used to assist in making an incision

Needles and Suture Material

I. Surgical needles are available in several sizes and forms (Figure 23-13)
FIGURE 23-13A, Basic components of a needle. B, Types of eyed needles. C and D, Needle body shapes and sizes. (From

Fossum TW: Small animal surgery, ed 3, St Louis, Elsevier Mosby, 2007.)

A. Can be straight, curved, half curved, or half circle
1. Curved needles are most commonly used
2. Curved needles are described by their circle size (e.g., 12-inch, 38-inch
circle)
3. Half-curved needles are straight except for a curved tip
B. Needle points are cutting or tapered (noncutting)
1. Type of cutting point can be reverse, triangular, or side cutting for skin, cartilage, or
tendons
2. Taper point needles are round or oval with reverse cutting points for tissues that may
tear easily
C. Needles can be eyeless (swaged) with suture already connected to the needle, or have an eye
(round, square) to place suture through
 1. Needles swaged on to the suture are less traumatic because needle size is relative to
suture size
2. A separate needle and suture can cause tissue damage if used improperly
a. Needle and suture should be similar in size
b. Thread suture through curved needles from the inside without tension
II. Commonly used absorbable suture material
A. Surgical gut is the most common nonsynthetic material
1. Commonly referred to as catgut
2. Made from the submucosal layer of sheep intestine
3. Broken down by phagocytosis
B. Examples of synthetic suture material
1. Polyglycolic acid (Dexon; Davis & Geck, Danbury, CT): synthetic polyester from
hydroxyacetic acid
2. Polyglactin acid (Vicryl; Ethicon, Somerville, NJ): copolymer of lactic and glycolic
acids
3. Polydioxanone (P.D.S.; Ethicon) and polyglyconate (Maxon; Davis & Geck): synthetic
polyester
4. Monofilament material provides less tissue drag when sutures are placed
5. In general, absorbable suture retains its strength for several weeks
III. Nonabsorbable suture material can also be natural or synthetic
A. Examples of natural fibers for suture material
1. Silk is considered nonabsorbable even though its tensile strength is usually lost after
6 months
a. Commonly braided or twisted into multifilament strands
b. Most commonly used for cardiovascular surgery
c. Can act as a wick, allowing migration of contamination
2. Cottons and linens have been used for suture material
3. Stainless steel suture is used in veterinary surgery but can be difficult to work with
because of its decreased flexibility
B. Examples of synthetic nonabsorbable suture material
1. Polypropylene (Prolene; Ethicon): synthetic plastic
2. Polyamide/nylon (Ethilon; Ethicon): polymerized plastic
3. Polymerized caprolactam (Vetafil; B. Braun, Melsungen, Germany): coated synthetic
fiber commonly used for skin closure
C. In general, nonabsorbable suture retains its tensile strength for 60 days or more
D. Table 23-1 summarizes and compares common suture materials

TABLE 23-1
Summary and Comparison of Common Suture Materials
 Brand Multifilament or Natural or
Generic Name Manufacturer Absorbability Color
Name Monofilament Synthetic

Nylon Ethilonok Ethicon Nonabsorbabl Monofilament Black Synthetic

(Somerville, e
NJ)
 Brand Multifilament or Natural or
Generic Name Manufacturer Absorbability Color
Name Monofilament Synthetic

Dermalon Davis & Geck Nonabsorbabl Monofilament Black Synthetic

(Danbury, e
CT)

Polyester Surgidac USSC (Norwalk, Nonabsorbabl Multifilament Green Synthetic

CT) e

Ethibond Ethicon Nonabsorbabl Multifilament Green Synthetic

e

Polyglactin Vicrylok Ethicon Absorbable Multifilament Purple/undye Synthetic

910 d

Polyglycolic Dexon- Davis & Geck Absorbable Multifilament Beige Synthetic

Plus

Polypropylene Surgilene Davis & Geck Nonabsorbabl Monofilament Blue Synthetic

e

Proleneok Ethicon Nonabsorbabl Monofilament Blue Synthetic

e

Polydioxanone P.D.S.ok Ethicon Absorbable Monofilament Violet/clear Synthetic

Silk Silk Davis & Geck Nonabsorbabl Multifilament Black Natural

 Brand Multifilament or Natural or
Generic Name Manufacturer Absorbability Color
Name Monofilament Synthetic

From Tear M: Small animal surgical nursing skills and concepts, ed 2, St Louis, Elsevier Mosby, 2012.
IV. United States Pharmacopeia (USP) sizing is generally used when asking for suture material
A. Example: 4-0 (pronounced 4 ought), 3-0, 2-0, 0, 1, 2, etc.
B. As the number increases to the right after size 0, the diameter of the suture becomes thicker;
thus the size increases (e.g., size 3 suture is larger than size 2 suture)
 C. As the number increases to the left of the 0, the diameter of the suture is thinner; thus the
size decreases (e.g., size 2-0 is larger than size 3-0)
D. Wire suture is also sized by gauge
1. Size varies from 18 to 40 gauge
2. The lower the gauge number, the thicker the diameter of the wire suture
V. Suture material and needle size used are based on many factors determined by the surgeon

Suture Techniques
I. There are many suture patterns used to close skin wounds
A. The most common are simple interrupted, simple continuous, horizontal mattress, vertical
mattress, Ford interlocking suture, and cruciate mattress (Figure 23-14)

FIGURE 23-14 Common suture patterns used in the skin. (From Aspinall V: Clinical procedures in veterinary nursing, St Louis, Elsevier, 2003.)

II. Procedure for simple interrupted pattern

A. Ensure the wound has a good blood supply
B. Select the appropriate suture material, needle holder, and rat-tooth forceps
C. With the needle positioned in the needle holders, stabilize the skin at the far side of the
wound
D. Push the tip of the needle through the skin toward you and under the skin
E. Use the forceps in the other hand to stabilize the side closest and push the need through the
underside of the skin
F. Pull the suture material through the skin
1. Each bite should be the same size as the first
G. Tie the ends in a reef knot or surgeons knot
1. The skin edges should be together so they are just touching
 2. This is called an appositional closure
3. Incisions can also be termed everted (tension tends to pull the wound edges apart)
a. Inverted sutures are used only on internal organs since they tend to create
dead space and delay healing
4. The knot can be tied by hand or by using the needle drivers
H. Cut the ends of the suture as short as possible
I. Continue suturing the entire wound

Tissue Adhesive
I. Cyanoacrylates (Super Glue; Super Glue Corporation, Rancho Cucamonga, CA) (tissue glue) is
commonly used to glue sides of surgical wounds together
II. A few drops of tissue adhesive bonds the edges of wounds together in approximately 10 to 15
seconds
III. The adhesion may be delayed by excess moisture or hemorrhage
IV. One drop is all that is required for feline declaw surgeries
A. Excessive amounts can lead to cracking and nonadhesion of the edges
V. The wound should be small, as dry as possible, and free of infection
VI. Complications due to improper use include dehiscence, granuloma formation, and fistulation of
infected wounds

Skin Staples and Skin Mesh

I. Skin staples can be used to close surgical sites
II. A special skin stapler and removal device is used
III. Staples should be bent inward so that they cannot be chewed out by the patient
IV. Surgical mesh is sometimes used to repair hernias as reinforcement material to devitalized tissues
V. Surgical mesh can be purchased in absorbable and nonabsorbable formats

INSTRUMENT CARE AND PACK PREPARATION

Stainless steel instruments are in general expensive and of high quality. If maintained well, stainless steel
instruments will last a lifetime.

Instrument Care
I. Instruments should be kept moist or washed immediately after use to prevent residue from drying,
which can cause staining, pitting, and corrosion
II. Clean instruments in distilled water and approved cleaning agents
A. Tap water should be avoided because it can leave mineral deposits on the instruments
during the sterilization process
B. Cleaning agents should have a pH between 9.2 and 11 to prevent spotting and corrosion
1. Commercial instrument cleaners are available
C. Instrument-cleaning brushes are helpful in removing debris from box locks, ratchets, and
teeth
III. Use an ultrasonic cleaner to clean instruments, because it is 16 times more effective than manual
cleaning
A. Instruments should be placed in cleaner with box locks and ratchets open
B. Do not overpack the cleaner with instruments
C. To prevent electrolytic corrosion, do not mix different metals in the same cycle
D. Run the cycle for approximately 10 minutes
 E. Rinse the instruments with distilled water to remove any mineral deposits left behind
IV. Place instruments in a surgical milk solution
A. The surgical milk solution is an excellent lubricant and rust inhibitor
B. In general, surgical milk must be used on all instruments cleaned by ultrasound, because all
traces of lubricants are lost in cleaning
C. After immersion in instrument milk, the instruments should be put on a clean paper or cloth
towel to drain
D. Surgical milk should be fresh so that it has no bacterial growth
E. Some prefer to use an instrument milk spray
F. Rinsing after lubrication is not necessary as most surgical milk solutions are steam permeable
and will not interfere with sterilization
V. Instruments should be examined before being packed for resterilization
A. Check that all surfaces are clean and free of foreign material
B. Make certain that box locks work smoothly and are not loose
C. Instrument tips should close tightly and evenly, especially tips on all forceps and needle
holders
D. Scissors should be sharp along the entire edge of the blade

Preparing Instrument Packs and Linens

I. Reusable linens, such as gowns, drapes, and skin towels, should be laundered in a separate washer
and dryer with minimal detergent
A. An extra rinse cycle should be used to ensure that no detergent residue is left
B. Leftover detergent residue can transfer via steam to surgical instruments during the
sterilization process
II. The packing of instruments and linens should be consistent and allow the greatest amount of steam
sterilization
A. Use of pans or trays with perforations to hold instruments can allow better steam
penetration and drying
B. Leave box locks and ratchets in the open position or locked no more than one click
C. Place heavier instruments on the bottom of the packs, and place items that are used first,
such as towel clamps, on top
D. Fold linens by the accordion-style method (fanfold)
1. Surgical gowns should be laundered and intact
a. Wrap inside out with all ties folded inside neatly and sleeves on top of the
gown
b. Gown pack can also include a towel for drying hands after a surgical scrub
2. Laparotomy sheets, drapes, and skin towels should be laundered and lint free
a. Wrap using the accordion pleat method and then fold into three sections
b. Some surgeons prefer to have one corner of the drape folded over for easier
grasping of the drape
E. Packs must fit the size of the autoclave and allow ample room for steam movement and
penetration
1. Size should not exceed 30 30 50 cm
2. Weight should not exceed 5.5 kg
3. Density should not exceed 115.3 kg/m 3

4. Space between packs should be 2.5 to 7.5 cm

III. The wrapping of instrument packs and linens should be consistent for proper sterile handling
technique when opened
 A. Place a minimum of two appropriate-sized wrapping materials in front of you in a diamond
shape
B. Place the instrument pack or linen in the center of the first or inner wrapper
C. Tightly pull linens with each fold
D. Begin with the corner nearest you and fold over the top of the pack
E. Take a small part of that corner and fold it back toward you to leave a tab
F. Do the same with one of the side corners, then the opposite side
G. The side farthest from you should always be folded over last
H. Tuck this last corner inside the two sides, leaving a tab that can be pulled to open
I. Repeat the same folding technique with the second or outer wrapper
J. Instruments should not be loose inside pack; everything should be tight and secure
IV. Indicator tape should be used on the outside of every pack and linen
A. Tape keeps the packs sealed tighter and prevents corners from unfolding
B. Useful for labeling information
1. Contents of item (e.g., large gowns, general packs)
2. Date item was sterilized
3. Initials of the technician who prepared and sterilized the pack
V. Sterilization pouches made of paper and/or plastic are useful for sterilizing individual items
A. Pouches can be sealed by heat or by rolling the ends three times and securing with indicator
tape
B. Make sure you tab one end of the tape for easier opening
C. Sterilize in an upright position to allow the best steam sterilization and drying
VI. Types of sterilization monitors
A. More than one sterilization monitor should be used to ensure optimum sterility of the pack
B. Indicator tape indicates only that an item has been exposed to steam or ethylene oxide
1. Lines on the tape will change color to black
2. Color change does not indicate that temperature has been met and maintained for a
certain period of time
3. Indicator tape on the outside of the pack means only the outside of the pack has been
exposed to steam
C. Chemical indicator strips change color when exposed to steam or ethylene oxide for a
specific period of time
1. Place indicator in the center of the pack in the least accessible place for steam:
between folds of drapes or gown. Do not place the indicator directly on instruments
2. Must remember to check the strip as soon as the pack is opened
D. A Bowie-Dick test is performed with a prepurchased dense pack with indicator tape in the
center
1. Place test pack in the most inaccessible location in the autoclave
2. Verifies steam penetration
E. Biological indicators are excellent monitors of sterility
1. Test for the most heat-resistant bacteria
2. However, they do not give an immediate answer
F. Visually check your autoclave to ensure that adequate time, temperature, and pressure have
been achieved for proper sterilization
VII. Length of time steamed autoclaved items remain sterile can be extended by the type of wrapping
material and where they are stored
A. Textile wrapping material can be bulky to use and must be laundered and in good condition
1. Cotton muslin should be double layered, and two wraps should be used for pack
preparation
 2. Higher thread-count cottons can use two single-layered wraps
3. If kept in open shelving, the items can remain sterile for 3 weeks
B. Disposable paper wraps can be crepe or noncrepe material that can be cut to the desired size
1. Crepe paper is easier to work with and more durable
2. Crepe paper is more expensive
3. Single-wrapped two-way crepe paper can remain sterile for 3 weeks with open
shelving
C. You can double the sterilization shelf life by keeping items in a clean, closed cabinet
D. For infrequently used items, wrap and store in sterilization pouches to extend the shelf-life
to 1 year in a closed cabinet
E. Ethylene oxide sterilization can also prolong the shelf-life of sterile items

PATIENT PREPARATION
The goal of patient preparation is to achieve asepsis or a preparation site free of germs that could cause disease
or decay.
I. Patient preparation should be performed outside of the operating room
II. Before clipping, the bladder may need to be emptied, either by walking the patient outside or
manually expressing the bladder
A. Caution may be warranted when expressing a patients bladder, and the surgeon should
be consulted before performing the procedure
B. An empty bladder can increase the space in the abdominal cavity and prevents the animal
from eliminating on the surgery table while under anesthesia
III. Surgical hair removal should be completed with electric clippers and a no. 40 blade
A. Blades should be clean and well lubricated and have no missing teeth that may tear the skin
B. Coolants prevent clipper blades from overheating
IV. Start clipping at the proposed incision site in the direction of the hair growth, then against the
direction of hair growth to minimize irritation from the clippers
A. Thick-coated animals sometimes require clipping with the direction of hair first, perhaps
using a no. 10 blade initially
B. Try not to allow clipped areas to touch unclipped areas
C. In general, clip more hair rather than too little hair (2 to 4 cm in each direction from
incision site)
D. By consulting with the surgeon and the patient file, determine the proper site and the size of
the site before clipping
E. Water-soluble lubricant should be placed in open wounds before clipping to prevent further
contamination from loose hair
V. Technicians should be familiar with common general patient preparation and animal placements for
surgery
VI. Common surgeries
A. Most laparotomies, such as the ovariohysterectomy (OHE), cesarean section, splenectomy,
celiotomy, gastrostomy, and cystostomy, require a ventral midline incision
1. Animals are placed in dorsal recumbency
a. Some surgeons prefer a flank incision for an ovariohysterectomy
(1) This requires positioning the patient in lateral recumbency
2. Hair is removed caudal to the xiphoid process and cranial to the pubis
3. Hair is removed laterally
a. For cats, remove hair approximately one clipper blade width past the nipple
line
 b. For large dogs, at least 4 inches (10 cm) of hair on either side of the
midline should be removed
4. The incision is made just caudal to the umbilicus in dogs and more caudally in cats
B. Canine castrations
1. Patient is in dorsal recumbency
2. Canine patients require hair removal from the scrotum and prepuce extending into
the inguinal area
a. Some surgeons prefer that the tip of the prepuce remain unshaven to reduce
irritation
b. Some surgeons prefer the prepuce to be flushed with chlorhexidine before
surgery
3. Use caution while shaving the scrotum to avoid clipper burn
4. Clip laterally into the inguinal area on both sides
5. Before the surgery, the patient should be examined for the presence of both testicles
before inducing anesthesia
a. If both testicles are evident, a routine castration can be performed
b. If only one testicle can be palpated, the dog is considered a cryptorchid or
monorchid
c. A cryptorchid surgery is considered an abdominal surgery or inguinal
surgery since the undescended testicle must be removed
d. This type of surgery takes a longer period of time and should be performed
at the end of the surgical time
C. Feline castrations require less hair removal and surgical preparation
1. The patient can be in either lateral or dorsal recumbency
2. Hair can either be plucked from the testes or, in long-haired patients, carefully
clipped from the area around the scrotum first
3. The patient is prepped with standard preparation solutions
a. Some surgeons prefer only a surgical scrub and final preparation, skipping
the disinfectant alcohol
b. The alcohol can be toxic and burn the delicate tissues of the scrotum
4. After the testicles have been removed the scrotum is left unsutured
D. Puppy dewclaw removal and tail docking as well as feline declawing do not require hair
removal before surgical scrub
E. For perineal urethrostomies, rectal fistulas, and anal sac surgeries, the animal is placed in
ventral recumbency with its hind legs hanging over the edge of the table
1. The tail is tied or clipped to the top or side of the body
2. Some surgical tables can be tilted upward for the surgeons comfort
3. Hair removal should be outward from the rectum and extended up the base of the
tail and down both legs
F. Spinal surgeries
1. The patient can be positioned in ventral recumbency for a hemilaminectomy and
dorsal laminectomy or dorsal for cervical spine surgeries
2. Spinal surgeries must be extremely aseptic, and therefore surgeons often use a
double draping technique
VII. Orthopedic surgeries
A. Orthopedic surgery is used to restore the function of the skeletal system
B. This area of veterinary medicine is considered a very specialized area
C. The patient should be stable and evaluated prior to orthopedic surgery
 D. Common orthopedic surgeries include: cruciate repair, patellar luxation, hip dysplasia,
OCD, and trauma cases
E. Patients require analgesia presurgery and postsurgery
F. Most patients require presurgical, surgical, and possibly postsurgical radiographs
G. Many patients require a splint or bandage prior to surgery
1. For example, Robert Jones or Modified Robert Jones bandages are commonly used to
stabilize hind limb fractures (see Chapter 24 for more information on bandaging)
H. Internal and external fixations may be used to support the limb
1. Internal fixation is generally the stabilization of the fracture using intramedullary
pins, plates, screws, interlocking nails, Kirschner wires, and cerclage wires
2. External fixation includes the use of casts, splints, ring fixation, or Kirshner-Ehmer
fixation
3. External fixation uses devices such as bars with clamps, nuts and bolts, or aluminum
rings to stabilize mostly long bones
I. Most orthopedic surgeries require a larger surgical prep area to enable the surgeon to
manipulate the limb (e.g., lateral and medial hind limb for a femoral intramedullary pinning)
1. The prep site for most hind limb surgeries is the hip to the tarsus
2. If performing a limb surgery, the unclipped area of hair on the paw should be
wrapped
3. Plastic wrap or examination gloves secured with tape work well
4. Wrapping the distal portion of the limb after the hair is clipped prevents loose hair
from sticking to the tape
a. Hanging limb preparation can be used for shoulder and hip surgeries
b. The about-to-be-operated limb is suspended by tape/rope from an overhead
hook or IV stand for the surgical scrub
c. After the prep is finished, the paw is wrapped with a sterile towel or sterile
stockinet for easy handling by the surgeon
VIII. Ophthalmic surgeries
A. There are several types of ophthalmic surgeries that are commonly performed in veterinary
practices, such as: entropion repair, eyelid tucking, neoplasm removal, and protrusion of the
third eyelid
B. For most ophthalmic surgeries, the patient is in sternal or lateral recumbency
1. Often sandbags are used to position the head
C. Clipping and cleansing of the area are important for sterile surgeries
1. Baby shampoo that is diluted to a 1:3 solution can be used for cleansing the eye area
2. Diluted Betadine (povidone-iodine solution) (1:50) can also be used with a soaked
gauze square to remove any debris from the site
3. The site is then wiped with sterile saline to remove any residual solution
4. If necessary, the eye can be flushed with sterile saline to remove mucus or debris
from the eye

Surgical Scrub
I. After clipping, a Dust Buster (Black & Decker, New Britain, CT) or central vacuum is useful to remove
all loose hair from the surgery site and the surrounding area of the preparation table
II. Recommended scrub solutions are chlorhexidine or povidone iodophor products
III. Surgical scrub procedure
A. Required equipment: gloves, gauze, sponge forceps, and scrub bowl
B. Begin at the incision and work outward in a circular motion
C. Never return to the incision area without getting a new gauze square
 D. Produce a good lather but do not scrub too hard
E. Scrubbing process should be completed a minimum of three times
1. Gauze squares should appear clean after the final scrub
2. Ask yourself if the skin is aseptic for surgery before continuing to the next step
F. A procedure of alternating each scrub with sterile saline or isopropyl alcohol is helpful
(because of its evaporative effect, be careful using isopropyl alcohol on small patients who
may be prone to having increased difficulty maintaining body temperature)
G. Final preparation should be completed so that the area of the incision is the most aseptic
1. Apply chlorhexidine or povidone-iodine as an antiseptic
2. There are at least three methods to accomplish the final aseptic application
a. Method 1: using a nonsterile gauze square with antiseptic, make the first
stroke medially down the incision line. Each subsequent stroke of antiseptic
is to the right or left of the incision site, ending at the outermost border
b. Method 2: begin the same way used in method 1, complete one side, and
use a new sponge soaked with antiseptic to complete the opposite side in the
same manner
(1) The objective is that no stroke of antiseptic is repeated, thereby
maintaining asepsis by moving any organisms away from the site
c. Method 3: at many practices, antiseptic spray is used as the final prep in the
operating room
(1) Be careful not to overapply final paint (prep), because the prep
solution could seep through to the drape
H. The final sterile surgical scrub is performed after the animal has been positioned on the
surgery table in the surgical suite
I. There is now a one-step procedure that is becoming more common
1. The solution is packaged in a bottle with an applicator sponge attached to it
2. After squeezing the bottle, the solution moves onto the sponge and is applied to the
patient
3. Starting from the incision site, working in an outward circular motion, the product is
applied to the clipped area
4. The application time requires 30 seconds and dries in 2 to 4 minutes
5. These types of solutions can only be used on clean, dry, intact skin
6. The patient cannot be scrubbed prior to the use of this one-step solution since it will
not adhere to any residual scrub solution that may not be removed from the skin
7. The patient may also have a reaction to the product since these solutions contain 70%
to 74% alcohol
IV. Once surgical preparation is completed, carefully move the patient (by gurney if available) into the
operating room, trying not to contaminate the surgical scrub
V. The patient should be tied to the table in the appropriate position
A. The knot should be a half-hitch on the limb to facilitate easy release in case of an emergency
1. Apply ties with two contact points per limb to reduce pressure problems
2. Do not secure too tightly; this may cause muscle problems
VI. Once patient is positioned and necessary monitoring equipment is in place, a final surgical
preparation is performed
A. Reapply antiseptic using one of the methods given
B. Repeat entire preparation if contamination occurs

DRAPING
After the animal is secured on the table and the final skin preparation is complete, the patient is ready to be
draped. (See Bassert and Thomas, 2014.)
I. Drapes maintain a sterile field
II. Draping is performed by a gowned and gloved surgical assistant or team member
III. Draping begins with the placement of field drapes (also called quarter drapes)
A. Field drapes are placed on the unprepared portion of the animal
B. These drapes are placed one at a time at the very periphery of the prepared area
C. After the drapes are in place, they should not be readjusted toward the incision site
1. Readjustment carries contaminants onto the prepared skin
D. Towel clamps are placed to secure the four corners of the drapes
1. Towel clamps secure the drapes to the skin and surround the incision site
E. Finally, a large drape or laparotomy sheet is placed over the animal with the center or
fenestration over the surgical site
1. Final drape provides a continuous sterile field

POSTOPERATIVE EVALUATION
I. Body temperature
A. Immediately postsurgery, every patient should have its rectal temperature taken every hour,
then every 4 to 12 hours based on the surgeon's orders
B. A 1 to 2 increase is normal in the first few days postsurgery due to the physiological
response to trauma
C. A prolonged temperature increase could indicate the beginning of an infection
II. Appetite and thirst
A. Postsurgical patients require high-protein diets to speed up recovery
B. Patients should begin eating and drinking in small quantities as soon after surgery as
possible
C. Obvious nausea may indicate gastrointestinal problems
D. Some pain medications (opioids) may reduce appetite
III. Defecation and urination
A. Urination should be monitored
1. Any hematuria or dysuria should be reported to the surgeon immediately
B. Defecation should be monitored
1. Gastrointestinal tract function and defecation may be reduced by some analgesic
medications

POSTOPERATIVE COMPLICATIONS
I. Hemorrhage
A. External hemorrhaging
B. Internal hemorrhaging
1. Bruising, oozing, or pale mucous membranes are signs of internal hemorrhaging
2. Pulse rate, capillary refill time, and packed cell volume can be used for evaluation of
the cardiovascular system
II. Hematoma and seromas
A. Hematomas are accumulation of blood usually beneath the incision site
B. A seroma is an accumulation of serum beneath the surgical site
1. In most cases hematomas and seromas are caused by dead space left by the
incision
2. The body will naturally remove small hematomas or seromas over time
 3. If a postoperative patient develops a large seroma or hematoma, the surgeon may
elect to place a drain in the area
III. Wound dehiscence
A. One of the most serious postoperative complications
B. The disruption of the surgical wound can be due to a number of reasons:
1. Tissue weakness
2. Suture failure (chewing, breakage, early suture breakdown, untying)
a. Patients who have the tendency to chew or lick incisions should be fitted
with an Elizabethan collar to prevent self-trauma
3. Excessive activity, chronic vomiting, or coughing
C. Evisceration of the abdominal organs may occur
1. This is when the abdominal organs move to the outside of the body
2. This is an emergency situation
3. The organs can become contaminated and bruised or mutilated by the patient
4. If this does occur, cover the organs and area with a sterile surgical cloth soaked in
sterile saline to keep the organs hydrated until emergency surgery can be conducted
IV. Infection
A. If the surgical wound is infected, the patient will exhibit the following signs
1. The incision and area may be swollen, red, and hot to touch
2. The patient may have an increased rectal temperature, show signs of depression and
poor appetite
3. If the infection is subcutaneous, an abscess may form
4. If the infection is in the abdominal cavity (peritonitis) or thoracic cavity (pleuritis),
this could lead to septicemia
5. The patient may be given oral or intravenous antibiotics postoperatively

Suture Removal
I. Sutures can be removed from a surgical site 10 to 14 days postsurgery
II. The wound should be examined for complete healing prior to removing the sutures
III. Equipment required includes forceps, suture removal scissors, or curved scalpel blade
IV. Procedure
A. Grasp the knot of the suture with forceps or fingers
B. Using suture removal scissors, cut one side of the suture under knot
C. Pull suture out of skin by grasping knot
D. The entire suture should be removed to prevent any abscessing of the wound closure
E. Count the number of sutures removed from the patient and note on the patient record

SURGEON AND STERILE ASSISTANT SURGICAL SCRUB

I. Purpose: remove dirt and grease, decrease bacterial flora from the hands and arms
II. Before scrubbing, set out sterile scrub brush and any packs and surgical equipment that may be
needed. Put on cap and mask, remove jewelry, and ensure that nails are fingertip length and that
fingernails are free of nail polish
A. There are many variations of a surgical scrub. All variations are based on timed or stroke
methods of scrubbing the surface of the hands and arms. For the purposes of this text, a
stroke method will be used as an example
1. Turn on water, checking for comfortable water temperature; thoroughly wash both
hands and arms; clean nails
 2. Begin with a sterile scrub brush or prepackaged soap/brushes; wet the brush and/or
apply antiseptic soap to it
3. Artificial nails harbor bacteria and should not be permitted
4. Scrub fingernails and tips of fingers; 30 strokes
5. Begin with one hand, scrubbing fingertips, divide each finger into four planes, using
20 strokes. Proceed in a methodical fashion from the baby finger to the thumb,
scrubbing each plane of each finger 20 times
6. Progress to the palm and then the back of the hand and lateral hand; 20 strokes
7. Move to wrist area, scrubbing all four planes; 20 strokes
8. Scrub the remaining portion of the arm, ending 2 inches (5 cm) proximal to the
elbow; 20 strokes
9. During the scrubbing process, keep hands upright with fingertips above elbows at all
times to move bacteria away from hands
10. Rinse the brush, apply more antiseptic to the brush, and begin the same procedure
on the opposite hand and arm
11. After right and left arms have been scrubbed, rinse hands and arms from the
fingertips to the elbows, continuing to hold hands upward
12. Drying of hands and arms: hold sterile towel away from the body. Using one side of
the sterile towel, dry one hand first, followed by the arm. Use the other side of the
towel for the opposite hand and arm
III. Gowning and gloving should be completed immediately after drying hands
A. Gowning
1. Hold gown by inside shoulder seams; carefully pick the gown up and away from the
counter
2. The gown will unfold open
3. Slide one arm into the sleeve and then the opposite arm into the remaining sleeve
4. Allow unsterile personnel to tie the gown
B. Gloves should fit snugly but not so tightly as to cut off circulation of the hands
C. There are two standard methods of gloving: open and closed
1. Open gloving
a. With left hand, grasp inside cuff of the right glove; pull glove over the right
hand and cuff of the gown
b. The left glove can now be handled with the gloved right hand by placing the
fingertips on the inside of the folded-back cuff of the glove and pulling it on
the left hand and over the cuff of the gown
2. Closed gloving (minimizes contamination)
a. With fingertips of the right hand covered by the cuff of the gown, pick up
the left-hand glove and place it on the covered left hand with fingertips of
the glove facing the shoulder
b. The thumb of the glove is on top of the left thumb
c. Pull the glove over the cuff and push the hand into it while pushing out of
the gown cuff
d. The same procedure is used for the right-hand glove
e. After both gloves are in place, the gloves can be repositioned for comfort
3. After gloving is completed, the hands should be held above the waist and in front of
the body

OPERATING ROOM CONDUCT

All operating rooms have the same strict rules that must be followed. Knowing and understanding aseptic
technique will help any technician adapt to any operating room.
I. Aseptic conditions must be applied to the surgical suite and the patient
A. Patients and surgery staff prep in another room
B. Only surgery-related equipment belongs in the operating room
C. Every item in the operating room must be removed and cleaned regularly with disinfectants
D. Pay particular attention to flat surfaces where dust can accumulate
E. Make sure surgery lights are clean and dust free before they are adjusted over a surgical site
F. Clean daily before surgeries begin and between cases
II. Proper surgical attire is a must
A. Scrubs are specially designed for operating rooms
1. Street clothes should never be worn
2. Smocks should be worn over scrubs while clipping hair and when outside the
surgical area
B. Surgical head attire should be a bouffant cap or a hooded cap
1. No hair should be exposed
2. Hooded caps cover both the head and neck and are useful for those with facial hair
C. Surgical masks are either molded or flat
1. Molded masks have a metal nose band to assist with fit, but provide less facial
coverage and can allow air to escape
2. Flat-style masks have pleats and a metal nose band to provide a more custom fit and
decrease the chance of allowing air to escape
D. Foot covers or surgery shoes must be worn
III. Talking in the operating room should be minimal
A. Talking can distract a surgeons concentration
B. Saliva weakens the filtration of the surgical mask
C. If you have to cough, turn head away from site and cough into mask
IV. Movement within the operating room should be limited, because the increased air movement can
increase the risk of contamination
A. Prepare any equipment that may be used before the surgery begins
B. An organized surgery suite layout will prevent movement in the room to retrieve needed
equipment and material
C. The surgery suite should be located in an isolated area of the hospital with decreased traffic
volume
V. An imaginary line should be drawn around the sterile field of the surgeon, operating table, and
instrument tray
A. When passing sterile equipment, do not cross that line but stand near it
B. Stand to the right or to the left, so the surgeon does not have to turn his or her back to the
patient
C. If you are an unsterile assistant and you need to move past the surgeon or surgical assistant,
do so back to back
D. Hold a sterilized packaged item away from your body when opening
E. When opening items wrapped as described earlier
1. Open the side farthest away from you using the tab
2. Proceed to open one side and then the other without allowing your arms to pass over
the top of the item
3. Then pull the last tab (one closest to your body) toward you, exposing the item or
second sterile wrap
 4. Only outer pack wrappers should be opened by unsterile personnel before surgery:
keeping the inner wrap closed ensures sterility of the contents
F. How to open items in sterilization pouches
1. Determine which end is marked to be opened
2. Hold both hands in fists with thumbs on top of your index finger
3. Grab each side of the pouch, holding it between your thumb and index finger
4. Separate the seal by rolling your fists outward as if peeling a banana
5. Lower part of your fist can apply pressure to the item in the pouch to prevent it from
sliding out
G. Always allow the surgeon to approach you to retrieve a sterile item or place the item in a
sterile manner on the pack
VI. Surgical gowns should be considered sterile only on the front side, above the waist to the shoulder,
and down the arms
A. Keep hands clasped in front, close to the body, and above the waist or above the surgery
table
B. If trading places, pass back to back with hands folded; never turn your back toward the
patient
VII. A sterile surgical assistant can perform the following functions
A. Receive sterile equipment
1. Lift items up and out
2. Do not reach over a patient or sterile field
B. Keep the surgical table organized and instruments clean
C. Anticipate and pass needed equipment and instruments
1. Pass in the correct position for immediate use
2. Tap the surgeons palm with the instrument to ensure proper contact
D. Maintain hemostasis for the surgeon
1. Place suction tip near tissue, not directly on the tissue
2. Dab area with gauze square; do not wipe
3. Keep an accurate count of the gauze squares used and discarded
E. Provide retraction of muscles and tissues with minimal trauma and good surgical exposure
F. Cut suture material after suture placement
VIII. If a sterile item touches an unsterile item, it immediately becomes unsterile and is discarded
A. Any item that is dropped, punctured, or wet is unsterile
B. The patients skin is aseptic, not sterile; avoid contact
C. If in doubt, it is not sterile

ACKNOWLEDGMENT
The editors and author recognize and appreciate the original work by Melanie K. Gramling and Rachael
Higdon, on which this chapter is based.
Please visit http://evolve.elsevier.com/Tighe/Brown/ to view additional figures, tables, and boxes that
accompany this chapter.

REVIEW QUESTIONS
1. Which type of scissors is used to cut drape material?
a. Metzenbaum
b. Bandage
 c. Operating
d. Mayo

2. Which instrument has no gripping teeth and is a self-retaining forceps used for delicate tissue?
a. Babcock
b. Allis
c. Ferguson
d. Roeder

3. Which is the most delicate towel clamps with a squeeze handle?

a. Backhaus
b. Roeder
c. Lorna
d. Jones

4. The forceps with longitudinal grooves and distal transverse grooves are called:
a. Rochester-Carmalt
b. Rochester-Pean
c. Rochester-Oschsner
d. Rochester-Halsted

5. Which is the surgical instrument designed to hold metal?

a. Doyen forceps
b. Halsted mosquito forceps
c. Mayo needle holder
d. Ferguson angiotribe

6. Which instrument can be used to cut through bone?

a. Wire-cutting scissors
b. Kern forceps
c. Verbrugge
d. Osteotome

7. The type of needle that would most likely be used when suturing a bladder is:
a. Cutting
b. Triangular
c. Taper
d. Side cutting

8. An example of nonsynthetic absorbable suture material is:

a. Silk
b. Surgical gut
c. Cotton
d. Linen

9. An example of nonabsorbable synthetic suture is:

 a. Polyglycolic
b. Polyglactin
c. Vicryl
d. Vetafil

10. Surgical preparation/clipping is performed with a no. _________ blade.

a. 10
b. 15
c. 25
d. 40

11. Prior to a canine castration, the prepuce may be flushed with ___________.
a. Chlorhexidine
b. Povidone-iodine
c. Roccal
d. Isopropyl alcohol

12. The appropriate pH for detergent used to clean instruments is _________.

a. 3 to 5
b. 7.5 to 8
c. 9 to 11
d. 13 to 15

13. Which statement is false regarding indicator tape?

a. Lines on the tape will change color to black
b. Indicator tape on the pack indicates that the inside of the pack has been exposed to steam
c. Indicator tape on the pack indicates that the outside of the pack has been exposed to steam
d. Color change does not indicate that the appropriate temperature has been met and maintained for
the appropriate time

14. The sterile surgical assistant can perform all of the following tasks except:
a. Organize the surgical table and instruments
b. Provide retraction of muscles and tissues
c. Open packs
d. Cut suture material

15. During which type of surgery might a rongeurs be used?

a. Onychectomy
b. Celiotomy
c. Orthopedic
d. Thoracotomy

16. Which of the following handheld retractors has three prongs at one end?
a. Army Navy
b. Gelpi
c. Meyerding
 d. Senn

17. A patient undergoing a gastrotomy is placed in _______ position. The patient is prepared for surgery
by using a no. 40 clipper and removing the hair from the ____________. Following the clipping of hair,
the surgical site is disinfected with ____________ solutions.
a. Ventral, umbilicus to pubis, chlorhexidine alternating with an alcohol scrub and a final povidone-
iodine paint
b. Dorsal, xiphoid process to pubis, chlorhexidine surgical scrub alternating with an isopropyl
alcohol scrub and a final prep of 10% povidone-iodine paint solution
c. Dorsal, last rib to pubis, surgical scrub soap, 5% alcohol, iodine soap
d. Ventral, umbilicus to pubis, alcohol and povidone paint

18. Which of the following small animal scalpel blades is used to sever ligaments?
a. No. 10
b. No. 11
c. No. 12
d. No. 15

19. All of the following statements regarding surgical milk are true, except it:
a. Is an excellent lubricant
b. Inhibits rust
c. Should be used on all instruments cleaned by ultrasound
d. Must be rinsed off

20. Which method of gloving minimizes the chance of contamination?

a. Alternating
b. Open
c. Closed
d. Semi-closed

CHAPTER 24

Small Animal Nursing

PHYSICAL EXAMINATION
I. Under the supervision of a veterinarian, veterinary technicians may conduct physical examinations
A. To assess a patient's anesthetic risk and prepare an anesthetic plan
B. To obtain a status or progress report for monitoring an animal's recovery
C. To verify medical record entries
D. To evaluate abnormalities or conditions that should be brought to the attention of the
veterinarian
II. A physical examination is the first step in assessing a patient and may indicate possible health
problems
III. All body systems should be checked
 IV. A routine should be followed to ensure that each area is thoroughly examined
A. Example: evaluating from the nose to tail, or system by system

General Appearance
I. Note the animal's general appearance, gait, behavior, temperament, and attitude
II. The environment of the animal should be noted
A. Vomiting/diarrhea, urination, defecation in the cage
III. An accurate weight, temperature, pulse, and respiratory rate should be recorded

Examination by System
The detection of physical problems is usually due to observing the animal and palpating, smelling, and
listening. The description of what is detected is also important. Size, color, rate, and appearance should be
included in the record. For the following systems, various clinical signs should be noted on the patient's file.
Vaccination history should also be reviewed.
I. Skin and coat
A. Examine the skin and coat
1. Shiny or dull
2. Skin turgor
a. Normal skin pliability depends on hydration of the tissues
b. To assess turgor: tent the skin at the thoracolumbar junction
(1) Avoid cervical area because of the extra skin in this area
c. If the skin returns rapidly to its initial position, it is normal
d. If the skin remains tented or returns slowly to normal resting position, it is a
sign of dehydration
(1) Mild (~ 5% dehydration), moderate (~ 8% dehydration), and
severe (> 10% dehydration) dehydration. See Fluid Therapy
section for more information
3. Alopecia or dryness
4. Lesions or obvious parasites, such as fleas, lice, mites, or ticks
B. Palpate the entire animal; note any lumps, swelling, or painful reactions to palpation
II. Eyes, ears, and nares
A. Examine the eyes and note
1. Reflexes and response to visual stimuli
2. Discharge from the eyes
a. Clear or purulent
3. Corneal changes
4. Color of conjunctiva
B. Manipulate the ear and note
1. Response to auditory stimuli
2. Debris in the ear canal or unusual or excessive odor
3. If the animal is shaking or tilting its head to one side
C. Nares
1. Discharge: color and consistency
2. Sneezing and patency
III. Gastrointestinal
A. Examine mouth, teeth, and gums
1. Signs of periodontal disease and halitosis
2. Fractured, missing, or discolored teeth
 3. Verify age in young animals
4. Check tonsils for enlargement
5. Excessive salivation or difficulty swallowing
6. Signs of malocclusion
B. Note color of mucous membrane
1. Mucous membranes should be a pale pink color
a. Abnormal colors are blue-purple (cyanotic), yellow (jaundice), bright red, or
muddy brown
C. Capillary refill time (CRT)
1. Press on gums and note when the color returns
2. If color returns in less than 1 second, CRT is normal
3. If color returns in greater than 1 second, CRT is increased and abnormal
D. Palpate the abdomen gently
1. Check symmetry from side to side
2. Check for distention
3. Note signs of discomfort during palpation
4. Assess the bladder size
5. Lymph node abnormalities
E. Examine the anal area for any abnormalities
1. Color
2. Anal gland abscesses, discharge, or inflammation
IV. Respiratory
A. Auscultate the chest
1. Using a stethoscope, auscultate the thorax dorsally and laterally
2. Listen for abnormal sounds, such as crackles, wheezes, and stridor
3. Be aware of referral sounds from the upper airway
a. Listen to the trachea to rule out this source
4. Be aware of a decrease or lack of breath sounds
B. Note pattern, rate, depth, and effort of breathing
1. Hyperventilation or hypoventilation
2. Panting or shallow breathing
3. Open-mouth breathing or panting in cats is especially abnormal
4. Watch for dyspnea
V. Musculoskeletal
A. Observe the animal's gait
B. Note obvious signs of joint swelling or displacement of joints
1. Lameness, dysplasia, or pain
C. Flex the limbs
1. Painful reactions
2. Range of motion
VI. Cardiovascular
A. Palpate femoral and dorsal pedal pulses
1. Strength and rate of pulses
B. Auscultate the heart and check pulses at the same time
1. Note irregularities between pulse rate and heart rate, which can indicate pulse
deficits
VII. Reproductive and urinary
A. Examine external genitalia
1. Redness or irritation
 2. Abnormal discharge, growths
3. Symmetry of testicles
VIII. Lymphatic
A. Lymph nodes may or may not be palpable
1. Lymph nodes should not be painful when palpated
2. Note signs of enlargement
B. Major lymph nodes and locations
1. Submandibular: located cranial to the angle of the mandible
2. Prescapular: cranial to the shoulder joint
3. Axillary: where the forelimb meets the body
4. Popliteal: dorsal stifle
5. Inguinal: in the inguinal area near the femoral artery and vein, where the hind limb
meets the body
IX. Neurological
A. Bright and alert
B. Check pupil size
1. Response to light
2. Pupils are of equal size
3. Nystagmus
C. Look for signs of ataxia or weakness
D. Check tail response and/or if there is anal tone
E. Response in all four limbs to painful stimuli
F. Levels of consciousness
G. Knuckling when walking

DRUG ADMINISTRATION
I. Drugs are administered in several ways
II. The route depends on type of medication and age and health status of the animal
III. Most common routes: oral, parenteral, and topical
IV. Whichever method is used, it is important to verify correct drug, patient, dosage, time, and route

Oral Route
I. Oral medications are contraindicated if
A. Patient is vomiting
B. There are injuries to the oral cavity or esophagus
C. Patient has decreased swallowing reflex
D. Any disease process is present that prohibits oral intake, such as pancreatitis
II. Medication can be a liquid, semisolid, tablet, capsule, or patch
III. Liquid is administered via syringe in the cheek pouch
IV. Tablets or capsules are administered by
A. Holding the patient's mouth open with one hand
B. Placing the pill at the base of the tongue with the opposite hand
C. Closing the mouth
D. Observing the animal swallow

Parenteral Route
I. Includes all medications that are injected
II. These drugs are not absorbed through the gastrointestinal tract
III. Commonly includes at least three routes
A. Subcutaneous (SQ or SC)
B. Intramuscular (IM)
C. Intravenous (IV)
IV. Occasionally, drugs may also be administered by other routes
A. Intradermal (ID)
B. Intraperitoneal (IP)
C. Intracardiac (IC)
D. Intratracheal (IT) (this route is used for emergency drug administration)
E. Intramedullary or intraosseous (IO)
F. Intranasal (IN)
G. Intraarterial (IA)
V. Subcutaneous injections
A. Solutions are injected under the skin using a 22- to 25-gauge needle
1. Vaccines are most commonly administered via this route
a. Because of the possibility of vaccine-induced tumors, the intrascapular
region in cats should be avoided
B. Usually where excess skin is available
1. Dorsally from the neck to the hips
VI. Intramuscular injections
A. Injections into the lumbar muscles or biceps femoris muscle using a 22- to 25-gauge needle
B. Epaxial administration is becoming more common
1. The epaxial muscle is located cranial to the ilium, caudal to the last rib, and lateral to
the spine
2. The needle should be directed at a 45-degree angle into the muscle
C. Small volumes of up to approximately 2 mL are recommended
D. Multiple sites may be necessary
VII. Intravenous injections
A. Via a needle, catheter or butterfly inserted into a blood vessel (Figure 24-1)
FIGURE 24-1 Intravenous butterfly. Monica Tighe, St. Clair College, Veterinary Technician Program, 2013
B. Most common sites: cephalic, femoral, saphenous, and jugular veins
1. Sublingual for emergency drugs
C. Alcohol is applied to the site before venipuncture to disinfect and part the fur
D. A restrainer or a tourniquet is used to apply proximal pressure to vein
E. By drawing blood into the syringe before injecting, correct placement may be ensured before
administering medication
1. Best to enter at a distal point on the limb
F. It is the fastest route of absorption and large volumes can be rapidly administered
G. Intravenous administration causes fewer problems if solutions are caustic, irritating, or
hypertonic
H. Intravenous catheters can also be inserted for long-term administration of medications or
fluids
VIII. Intraosseous route
A. Needles are placed directly into the bone cavity for administration of fluids, drugs, or blood
products
B. This method is most commonly used for neonatal and smaller animals and animals with
circulatory problems
C. Sites of administration
1. Femur, humerus, tibia, and sometimes the ilial wing or ischium
D. A 15- to 18-gauge bone marrow needle is commonly used
1. In small neonatal animals, an 18- to 22-gauge hypodermic needle may also be used
E. Sterile technique must be used to prepare the skin for needle placement

Topical Route
I. Medications applied directly to the skin
II. Can be applied directly on top of lesions
 III. The area must be clipped and clean before applying medication
IV. Directions must be followed carefully
A. Absorption rate is variable and depends on the amount applied and how quickly it is
absorbed
V. Wearing gloves as a precaution is sometimes advisable for certain medications
VI. Dermal patches can be applied for postsurgery analgesia administration

FLUID THERAPY
I. Fluid therapy is one of the most common procedures performed in veterinary medicine
II. It is used as supportive therapy in sick and injured patients
III. It is also used to maintain blood pressure in patients undergoing surgical procedures

Normal Fluid Balance

I. The body is made up of approximately 60% water
II. This is divided into intracellular and extracellular fluids
III. The body maintains fluid balance on a constant basis
IV. Fluids are gained via
A. Oral intake
B. Metabolism in the body
V. Fluids are lost by
A. Respiration
B. Excretion
C. Minor routes, such as sweating and milk production

Abnormal Fluid Losses

I. Vomiting and diarrhea
II. Increased respiration (panting) in dogs
III. Disease with accompanying polyuria
IV. Any chronic or acute injury or disease that causes fluid loss
V. Any disease state or injury that prevents or decreases the oral intake of fluids
A. Changes in volume (e.g., dehydration, blood loss)
B. Changes in blood chemistry (e.g., hyperkalemia)
C. Changes in distribution (e.g., pleural effusion)

Signs of Dehydration
I. Indicators of dehydration can be found during a physical examination
A. Evaluating weight and temperature
B. Skin turgor, decreased urine output (normal production is 1 to 2 mL/kg/hr)
C. Mental status
D. Pulse rate and quality, blood pressure
E. CRT, mucous membrane color
F. Packed cell volume (PCV), total protein (TP), specific gravity of urine (> 1.045), blood urea
nitrogen, creatinine, electrolytes, and blood gases

Estimating Degree of Dehydration

I. Mild: ~ 5% dehydration
A. Semidry mucous membranes, minimal loss of skin turgor
 B. Skin turgor is assessed by tenting or manipulation of the skin in the thoracolumbar junction
of the dorsal area
II. Moderate: ~ 8% dehydration
A. Moderate loss in skin turgor, dry mucous membranes, weak rapid pulse, and enophthalmos
(sunken eyes)
III. Severe: ~ 10% or greater dehydration
A. Definite loss of skin turgor
B. Tachycardia
C. Extremely dry mucous membranes
D. Weak/thready pulse
E. Hypotension
F. Altered state of consciousness
G. Severe enophthalmos

Types of Fluid
I. Crystalloidto replenish interstitial deficits
A. Isotonic electrolyte solutionsosmolality equal to blood
1. Most commonly used
2. Examples: lactated Ringer's solution (LRS), 0.9% saline or normal saline (also called
physiological saline), Plasmalyte 148, Normosol-R
B. Hypotonic solutionosmolality less than blood
1. Examples: 5% dextrose in water, 0.45% NaCl, Normosol-M, and Plasmalyte 56
C. Hypertonic solutionosmolality greater than blood
1. Examples: 3% and 7% hypertonic NaCl
II. Colloid
A. Solutions containing protein or starch molecules
B. This type of fluid is designed to stay in the vascular space and expand volume
C. Useful in patients with cerebral or pulmonary edema and hypoproteinemia
D. Used when crystalloids are not effectively improving blood volume
1. Examples: large patients, emergency surgery, large fluid loss
E. Since colloids tend to last longer in the body, they may be used when there is a need for a
longer duration of fluids
F. Examples of synthetic colloids
1. Hydroxyethyl starch such as hetastarch, tetrastarch, or VetStarch
2. Synthetic colloids may cause coagulopathy
G. Examples of natural colloids
1. Plasma or albumin solutions
III. Colloid and crystalloid combinations
A. Total doses of each fluid can be decreased and side effects are minimal
B. Prolonged effects of colloids
C. Examples: hetastarch and 23.4% NaCl in a 2:1 ratio to dilute hypertonic saline to a 7%
solution

Calculation of Fluid Replacement Volume

These values are meant only as guidelines. Every patient should be assessed on an individual basis.
I. Emergency fluid therapy
A. For hypovolemic, shocky, or severely dehydrated patients, isotonic crystalloid fluids should
be administered at 50 to 55 mL/kg intravenously for cats and 80 to 90 mL/kg for dogs
 B. Begin by giving 25% of the calculated shock dose
C. Reassess the needs of the patient after 25% of the fluids have been administered
D. Once shock is stabilized, continue fluids over 6 to 8 hours with the calculated volume
depending on the patients renal function and cardiac output
E. The dose for colloids for dogs is 20 mL/kg/hr (divide into 5-mL/kg boluses and reassess)
F. The dose for colloids for cats is the range of 10 to 20 mL/kg per 24 hours (typically
10 mL/kg in 2.5- to 3-mL/kg boluses)
II. Replacement fluids
A. Restoring normal fluid and electrolyte status within 24 hours
B. Daily fluid requirement = replacement + maintenance + ongoing losses
1. Replacement requirement = % dehydration body weight (kg) 10
a. The estimated % dehydration should only be used as a guide
(1) The estimate can be inaccurate due to chronic conditions, age, and
nutritional status
2. Ongoing losses can be estimated by the daily volume of fluids lost as urine, diarrhea,
vomit, or drainage from a wound over a 24-hour period
a. Examples of replacement fluids include Normosol-R or LRS
(1) Maintenance fluids low in sodium should not be used as
replacement fluids because they may lead to hyponatremia and
hyperkalemia when administered in large volumes
III. Maintenance fluids at the rate of 2 to 3 mL/kg/hr for cats and 2 to 6 mL/kg/hr for dogs
A. Example: Normosol-M
1. Maintenance fluids are indicated for patients that are not eating or drinking and
have no ongoing losses
2. Administering replacement fluids such as LRS for maintenance may lead to
hypernatremia and hypokalemia because these solutions contain more sodium and
less potassium than the patient normally requires
3. This could happen in patients who have vomiting and diarrhea or are anorexic
because the kidneys do not conserve potassium well
IV. Anesthesia fluid therapy
A. Perianesthetic fluid therapy is one of the most common types of fluid therapy
B. The advantages of perianesthetic fluid therapy in healthy animals include:
1. Support of the cardiovascular function, blood pressure, and vasodilation
2. Correction of losses
3. Decrease clot formation in the intravenous catheter, which may be needed as an
emergency route
C. The disadvantages of perianesthetic fluid therapy in healthy animals
1. Potential of vascular overload
D. Recommended amount is 3 mL/kg/hr for cats and 5 mL/kg/hr or < 10 mL/kg/hr (the
maintenance rate plus any ongoing losses) for dogs
1. Cats require less fluid due to their small blood volume
2. Preoperative fluid loading is not recommended
3. Reduce the fluid rate if the anesthetic lasts greater than 1 hour
E. Blood pressure is used most commonly to estimate tissue perfusion during anesthesia
1. Hypotension under anesthesia is a common occurrence in healthy patients
2. Anesthetic depth is most commonly the cause of hypotension
3. If hypotension is due to peripheral vasodilation
a. Decrease anesthetic depth
b. Start an intravenous fluid bolus of 3 to 10 mL/kg. Repeat as needed
 c. If not responding, administer a colloid such as hetastarch slowly
(1) Dose rate 5 to 10 mL/kg for dogs and 1 to 5 mL/kg for cats
(2) This must be titrated slowly, and blood pressure should be
measured every 3 to 5 minutes
(3) Colloids will increase the blood pressure better than crystalloids
d. If the patient does not respond and is not hypovolemic, the patient may
need drug therapy such as vasopressors or a reevaluation of the anesthetic
technique
F. Postanesthetic fluid therapy
1. Patients who may require fluid therapy postanesthesia include: geriatrics, patients
with renal disease, and patients with ongoing fluid losses from gastrointestinal
disease

Contraindications for Fluid Therapy

I. Patients may have existing conditions that may contraindicate the rapid replacement of fluid
II. Conditions that carry a risk of pulmonary edema from fluid shifting into the lungs necessitate the
need for caution and frequent monitoring
III. Some conditions that are contraindications for rapid fluid therapy are
A. Pulmonary contusions
B. Existing pulmonary edema
C. Brain injury
D. Congestive heart failure
IV. Signs of overhydration
A. Restlessness, increased respiratory rate, peripheral and pulmonary edema, weight gain,
increased lung sounds (crackles and wheezes), chemosis (edema of ocular conjunctiva), and
pitting edema
V. Signs of underhydrationadministration of fluid therapy
A. Tachycardia, poor pulse quality, hypotension, urine output
VI. Subsequent body weights, urine production, and urine specific gravity should be monitored
regularly
VII. Fluid rates should be adjusted according to patient response and veterinarian orders

Routes of Fluid Administration

I. Oral
A. Contraindicated if animal is vomiting and/or has a disease such as pancreatitis
B. Can be given by syringe
C. Can be given by feeding tube
1. Nasoesophageal or nasogastric tube directly into the stomach or intestinal tract
II. Subcutaneous
A. Useful for mild dehydration
B. Fluids must be isotonic; therefore, cannot contain dextrose
C. Contraindicated with patients in shock or with more severe cases of dehydration
1. In these cases, peripheral circulation is very poor and very little absorption will take
place
D. Absorption can take up to 6 to 8 hours
E. Approximate guidelines: 50 to 100 mL of body-temperature fluids at each site
F. Administration can be by large-gauge needle and syringe, or needle attached to an
administration set and intravenous bag
 G. Can be administered anywhere there is excess skin
1. Dorsally, between the scapulas
2. Dorsal flank area
III. Intravenous
A. Preferred method for correction of moderate to severe dehydration and patients in shock
B. Commonly administered via catheter (Figure 24-2) through cephalic, saphenous, or jugular
veins

FIGURE 24-2 Intravenous catheter. (Courtesy Monica Tighe, St. Clair College, Veterinary Technician Program, 2013.)

1. Fluids can be administered by a gravity-fed system or infusion pump

a. Gravity-fed administration is simply keeping the bag of fluids above the
body of the patient
(1) The fluid rate is manually adjusted by the roller clamp on the
administration set
(2) The rate of administration is dependent on the body position of the
animal
b. Infusion pumps can be either volumetric or photoelectric eyetype pumps
(1) Using an infusion pump ensures the accuracy of the amount of
fluid administration
(2) Volumetric pumps can be programed to deliver any volume of
fluid over a specific amount of time
(3) A photoelectric eyetype pump can count the drops of solution
as they are administered to the patient
(4) Using a sensor, the pump adjusts the number of drops per minute,
which is programmed into the machine
2. Buretrols can be added to administration sets
a. Buretrols are plastic cylinders that contain 50 to 150 mL of fluid
 b. They are used for precise dosing and to prevent fluid overload while using
the gravity-fed administration method
IV. Intramedullary
A. Useful in small or young patients where quick venous access is not possible
B. Fluids administered directly into the bone marrow cavity, for rapid absorption
C. Injected through the head of the femur or humerus
D. Strict aseptic technique must be used, and local anesthetic may be needed because this
procedure can be painful

VENIPUNCTURE
I. Purposes
A. For clinical pathology tests, such as complete blood cell count (CBC) or serum chemistry
tests
B. To administer medications or fluids
II. Equipment and supplies
A. Cotton balls soaked with 70% alcohol (isopropyl)
B. A 3- or 12-mL syringe or Vacutainer holder
C. A 20- to 22-gauge needle
D. Blood collection tubes, with or without anticoagulant (ethylenediaminetetraacetic acid
[EDTA])
1. Blood collection tube selection will depend on which laboratory tests are requested
by the veterinarian
III. Restraint and handling
A. Jugular vein
1. Animal should be in sternal recumbency on table
2. The restrainer should grasp the animal's front legs with one hand and the animal's
head with the other hand, extending the neck to expose the jugular vein
a. It may be easier to facilitate venipuncture if the patient is positioned
hanging over the edge of the table with legs below the table surface
B. Cephalic vein
1. The animal should be in sternal recumbency on an examination table
2. The restrainer should extend the animal's front leg by placing the fingers of one hand
behind the animal's elbow
3. To compress the vein
a. Use a tourniquet tightened cranial to elbow; or
b. The restrainer can use the thumb or first two fingers to roll and compress or
hold off the vein
C. Lateral saphenous vein
1. The animal should be in lateral recumbency
2. The restrainer can extend the stifle and compress the vein by grasping the animal's
distal thigh or proximal tibia
D. Femoral vein (feline patients)
1. Place animal in lateral recumbency
a. Cats may prefer sitting on a table with hind leg extended
2. The restrainer can place one hand on the medial side of the upper thigh to compress
the vein
IV. Procedure
A. Prepare venipuncture site
 1. Clip the site with a no. 40 blade
2. Check that the needle, syringe, and Vacutainer sizes are appropriate for collection
a. Also check for needle burs and sterility
b. Bevel of needle should be upward toward the venipuncturist
(1) This is so that the needle facilitates flow of the incoming blood and
is not occluded by the vein
3. Swab the area with alcohol
4. Have restrainer hold off vein
B. Collect blood
1. Insert the needle bevel up, approximately three fourths of its length into the vein
a. It is preferred to bury the needle in veins of most medium- to large-sized
dogs so that, if there is movement or a change in the position of the animal,
the needle will remain in the vein
b. For smaller animals, approximately half of the needle should be inserted
2. Pull back on the plunger and check for a small amount of blood in the hub of the
needle
3. Using a gentle force, continue to pull back on the plunger of the syringe until the
syringe is full or the required amount of blood is collected
a. The restrainer should continue to hold off until the required amount of
blood is collected or until the venipuncturist says that compression can be
ended
4. After the blood is collected, the restrainer should be directed to stop the compression
of the vein and the venipuncturist can then remove the needle
a. It is best to have the restrainer at this point apply light pressure over the
venipuncture site for hemostasis
C. Store sample
1. The blood is placed in a Vacutainer using sterile technique
a. The top can be removed from the Vacutainer and the blood can be gently
squirted into the Vacutainer
b. The Vacutainer can be punctured using the needle and the blood can be
injected into the Vacutainer (the Vacutainer should have a vacuum, and
therefore the blood will automatically be suctioned into the Vacutainer)
c. If the venipuncturist used a Vacutainer, it should be completely filled for the
sample to be viable
2. At this time the Vacutainer should be gently rocked for all of the blood to be mixed
with EDTA (lavender-top Vacutainer) or left in a rack for the blood to clot (red-top
Vacutainer)
3. The Vacutainer should be labeled with the name of the patient, date, and the initials
of the venipuncturist
V. Administration of drugs
A. The procedure for the administration of drugs is the same as for a collection except that,
after the venipuncturist is positive that the needle is in the lumen of the vein (blood in hub of
needle), the restrainer must remove the compression of the vein to facilitate the induction of
the drug

BLOOD COLLECTION AND TRANSFUSION

Canine Blood Collection for Transfusion
I. Dogs have many identified canine blood groups
 A. They are designated by the acronym DEA (dog erythrocyte antigen) and a number (e.g.,
DEA 1.1, DEA 1.2, DEA 3, 4, 5, and 7)
1. These types can be identified by blood testing
a. Rapid blood typing cards are used to detect DEA 1.1
b. The presence of antiDEA 1.1 antibody in a recipient will cause
agglutination and hemolyis if DEA 1.1positive blood is transfused
2. DEA 4 is the most common canine blood type
3. Dogs with DEA 4 antigen are considered to be the universal donors
B. After the first transfusion, dogs should be cross-matched because they can become sensitive
to the type of blood they received
II. Canine donor requirements
A. Any breed or sex may be used
B. A dog with a good temperament and easily accessible veins is a prime candidate
C. Ideally, donors should be neutered and weigh more than 25 kg (55 lb)
D. Donors can be between 1 and 7 years old
E. Donors should be tested every 6 months for parasites, including:
1. Heartworm (and maintained on a preventive medication)
2. Intestinal parasites
F. Donors should be fully vaccinated
1. Blood should not be donated for 11 to 12 days postvaccination because of vaccine
effects on platelets and endothelial functions
G. Donors must be in excellent health with yearly normal blood chemistry, CBC, and urinalysis
1. Donors' PCV should be at least 40%
2. Donors should also be tested for von Willebrand factor and normal platelets
3. Dogs with DEA 4 blood type only and negative for all other types of blood
4. Dogs positive for DEA 1.1 may be used as donors for DEA 1.1positive recipients
only
H. Donors must be free of the following infectious diseases
1. Blood parasites: Babesia canis, Haemobartonella canis
2. Rickettsial diseases: Ehrlichia canis, Ehrlichia platys, Borrelia burgdorferi, and Rickettsia
rickettsii
I. Donors should be fasted before donation to decrease lipemic samples of blood
J. Donors should never have received a blood transfusion
K. A maximum of 450 mL can be collected from a dog once every 4 to 5 weeks
III. Supplies
A. Sedation requirement depends on the animal
1. Do not use acepromazine maleate because it causes hypotension
2. The sedative of choice is oxymorphone given approximately 15 to 20 minutes before
blood collection
B. A blood collection bag with anticoagulant added
C. Clippers and surgical scrub solutions for preparation of the veins
D. All supplies for intravenous fluid administration should also be available
E. Scale to measure the blood
1. The total weight of the blood (470 gm) plus the weight of the collection bag and
anticoagulant (117 gm) should be 587 gm
IV. Procedure
A. Sedate animal
B. Place animal in lateral recumbency with neck extended
C. Clip a wide area around the jugular vein to be used for collection
 D. Clip and prep the skin over the cephalic vein for an intravenous catheter for fluid
replacement after blood collection
E. Place cephalic catheter
F. Prepare jugular vein for blood collection
G. Restrainer should be prepared to hold off the jugular vein in preparation for the blood
collection
H. Insert 16-gauge needle attached to the blood collection bag into the jugular vein in a cranial
direction
1. Blood bags are manufactured with the needle and tubing attached
I. As blood enters the collection bag, move the bag slightly to mix the anticoagulant with the
blood
J. A total of 450 mL of blood constitutes one entire blood collection
K. Use the scale to measure the volume of blood in the collection bag so that it is not overfilled
or underfilled
1. Overfilling or underfilling the blood collection bag results in an improper ratio of
anticoagulant to blood volume
L. After completion of blood collection, apply pressure to the jugular vein for 2 minutes to
minimize hematoma formation
M. The amount of blood collected from a canine donor should not exceed 10 to 20 mL/kg
1. Most facilities bleed a donor no more than once per month
N. Multiply the volume of blood collected from the patient by three to determine the volume of
replacement intravenous fluids
O. Clearly label the collection bag with the donor's name, collection and expiration dates, and
the donor's PCV, TP, and blood type
P. The donor should be observed for 1 hour after donation; mucous membrane color, pulse, and
CRT should be monitored

Feline Blood Collection for Transfusion

I. Feline donors are not routinely typed before blood collection
A. The AB system of blood typing is used for cats
1. There are three recognized blood types: A, B, and AB
a. The most common blood type is A
(1) Most cats in North America are blood type A
b. Nearly all domestic shorthair and longhair cats have type A
c. Many purebred cats have type B blood
B. Feline blood typing cards are available
1. Blood typing involves agglutination reaction with antitype antibodies
C. Since cats have naturally occurring alloantibodies against the blood-type antigen they lack,
there is no universal feline blood donor
1. Type A cats should receive type A blood, type B cats should receive type B blood.
Type AB cat can receive either type A or type B blood with no clinical reactions
2. Cats can have severe reactions to the first transfusion due to the inheritance of
preformed antibodies to the opposite blood group
3. Cats should always have their blood typed and crossmatched before the first and
subsequent transfusions
II. Donor requirements
A. Less than 8 years of age
B. A lean body weight of no less than 4.5 kg (10 lb)
C. Donor must be neutered or spayed
 D. A good-natured indoor cat makes donation smoother and less stressful
E. The donor should be fully vaccinated
1. Modified live vaccine may affect platelet and endothelial function, and therefore
blood should not be donated for 11 to 12 days postvaccination
F. Excellent health must be maintained by monitoring serum biochemistry, CBC, urinalysis, and
fecal tests on a yearly basis
1. The donor's PCV should be approximately 35%
G. All donors must be negative for feline leukemia, feline infectious peritonitis, feline
immunodeficiency virus, and Haemobartonella felis
H. A donor may provide 50 to 70 mL of blood no more than once every 4 to 5 weeks
III. Supplies
A. Sedation
B. Clippers and surgical scrub solutions
C. Appropriate size catheter and butterfly (19 gauge)
D. Anticoagulant
E. Intravenous fluids
IV. Procedure
A. The area is aseptically prepared and a catheter is placed in the cephalic vein for fluid therapy
B. Animal is sedated to effect
C. Monitor vital signs (pulse, respiration, and blood pressure) throughout the procedure
D. Administration of replacement fluids can begin approximately halfway through the
donation
E. Clip and aseptically prepare the skin over the jugular vein
F. Place cat in lateral recumbency with neck extended, or place cat in sternal recumbency with
neck extended and legs over the edge of the table
G. Insert 19-gauge butterfly into the jugular vein
H. Connect the butterfly to a 60-mL syringe containing 8.5 mL of anticoagulant
I. Always try to minimize movement of the needle in the jugular vein
J. Mix anticoagulant and blood often throughout the donation
K. Blood collection from cats is a slow process; patience is a must
L. Collection is complete when the syringe reaches a volume of 60 mL
M. Remove butterfly and apply pressure to the vein to minimize hematoma formation
N. Multiply the volume of blood collected from the patient by three to determine the volume of
replacement intravenous fluids (180 mL)
O. Clearly label the syringe with the donor's name, PCV, TP, volume, and date of collection

Administration and Reactions

I. Patient history should be checked for previous transfusions
A. Before the transfusion, all vital signs are observed and recorded
II. All blood products should be administered at room temperature using an in-line filter to remove
debris and clots
III. Flush intravenous lines with only sodium chloride solutions during transfusions of blood products
A. Flushing intravenous lines with any other fluid or solution may cause red blood cells (RBCs)
to clump, swell, or cause subsequent hemolysis
IV. For platelet administration, administration sets should not contain latex, because platelets will
adhere to it
V. Initial administration should be slow (0.25 mL/kg) for the first 15 to 20 minutes
VI. If there are no signs of a transfusion reaction, the transfusion can be continued at the rate of 5 to
10 mL/kg/hr to a maximum of 22 mL/kg per dog
 VII. Transfusion reactions can be either immunological or nonimmunological
A. Immunological
1. Acute immunological transfusion reaction signs include hypotension, vomiting,
salivation, muscle tremors, and tachycardia
2. At 7 to 10 days posttransfusion, the recipient's body will destroy RBCs
3. Delayed hemolytic reactions sometimes follow multiple transfusions
a. A key indicator of delayed reaction is an unexpected drop in PCV 2 to 21
days posttransfusion
b. Reactions may also be due to blood element incompatibilities
B. Nonimmunological signs are due to vascular overload
1. Signs include respiratory disease and vomiting
VIII. For blood and chemistry evaluation, see Chapters 2 and 3

Shelf-Life
I. Blood in heparin or sodium citrate
A. Must be used within 48 hours because of the lack of RBC preservative
1. Chemical changes could result in rapid removal of RBCs from the recipient's
circulation
II. Blood with acid citrate dextrose or citrate phosphate dextrose (CPD)
A. Blood should be stored at 33 to 36 F (1 to 6 C)
B. Can last up to 14 to 21 days in preservative when refrigerated
C. Blood stored with CPD-1 (added RBC preservative adenosine) can be stored for 35 to 45 days
III. Packed red cells without preservative
A. Can last 21 days refrigerated (reconstitute with 1:1 saline)
B. Cannot be frozen
IV. Fresh frozen plasma (FFP)
A. FFP is stored at 4 F to 22 F ( 20 C to 30 C) for up to 1 year
B. Plasma should be thawed to 98.6 F (37 C) in a warm water bath for approximately 30 to
60 minutes before administration
V. Platelet-rich plasma
A. Should be used within 48 hours, kept at room temperature, and protected from light

Indications for Use of Blood Component Therapy

I. Fresh whole blood (should be transfused within 4 to 6 hours)
A. Used for hemorrhagic shock, anemia, excessive surgical hemorrhage, bleeding disorders
(due to thrombocytopenia or clotting factor deficiencies), nonimmune-mediated hemolytic
anemia, and in some circumstances, immune-mediated hemolytic anemia
II. Packed RBCs
A. Fluid balance and osmotic pressure are maintained with crystalloid given with packed cells
B. Used for hemolytic anemias and nonregenerative anemias
C. The preservative ADSOL will maintain cells without having to reconstitute them
1. Approximately 200 mL packed RBCs in 100 mL of ADSOL
2. Always add ADSOL to the packed RBCs
a. If packed RBCs are added to the ADSOL, the cells may be damaged in the
process
III. An alternative to packed RBCs is Oxyglobin solution (bovine hemoglobin)
A. There is no need for blood typing or crossmatching
B. Transfusion reactions are not generally seen in the canine patient
 1. Cats may show signs of pulmonary edema
2. Bovine plasma is a colloid solution and can cause volume overload if administered to
patients with renal or heart failure
3. Overload can also occur if given rapidly or in large amounts
4. Discoloration of serum, urine, and mucous membranes is often seen after bovine
hemoglobin administration
C. Oxyglobin can be stored for up to 3 years
IV. Plasma
A. Used for volume expansion (shock and burn patients), hypoproteinemia, pancreatitis, sepsis,
and liver toxicities
V. Platelet-concentrated or platelet-rich plasma
A. Mainly used for thrombocytopenia cases

ELECTROCARDIOGRAPHY
Definition
I. Recording of the electrical activity on the surface of the body generated by the heart
II. Electrocardiograph: a machine that makes a recording of the bioelectrical signals on the surface of the
body that arise from within the heart
A. Electrocardiogram (ECG or EKG): a recording of the heart's bioelectrical signals on heat-
sensitive paper or on a monitor
III. An ECG represents amplitude (amount of electrical activity) and duration (length of time) of
electrical activity
IV. Each contraction of the heart is preceded by an electrical wave front that stimulates the heart muscle
to contract (systole) and then relax (diastole) in preparation for the next heartbeat
A. Depolarization: contraction of the myocardium
B. Repolarization: relaxation of cells after depolarization
V. The continuous wave of electricity through the heart is organized, rhythmic, and repetitive
A. The sinoatrial node, or pacemaker of the heart, is the point of origin of electrical activity
B. The cells of the heart are electrically linked; therefore, the depolarization spreads quickly
from the sinoatrial node to the atria in a caudal direction toward the ventricles, finally
reaching the atrioventricular (AV) node
C. Electrical activity moves slowly from the AV node and into the proximal portions of the
ventricular conduction system known as the bundle of His
D. From the bundle of His, the depolarization moves to the interventricular septum. This is
depolarized in a left-to-right direction
E. The current then moves along the left and right bundle branches to the apex of the heart,
where the Purkinje fibers direct the wave of depolarization through the ventricles in a cranial
direction
VI. The parts of an ECG are associated with the waves of electrical activity that spread through the
heart. The parts are labeled P, QRS, and T (Figure 24-3)
FIGURE 24-3 Normal lead II complex. (Courtesy Loncke D, Rivait P, Tighe M: Clinical procedures handbook, Windsor, Ontario, St Clair College, Veterinary

Technician Program, 2013.)

A. P wave: ECG representation of the depolarization of right and left atria
B. P-R interval: ECG representation of the beginning of atrial depolarization into ventricular
depolarization
1. This interval is mainly a result of slow conduction through the AV node
2. This interval is only the measurement of time
C. QRS complex: ECG expression of ventricular depolarization
D. T wave: ECG expression of repolarization of the ventricular myocardium
E. Atrial repolarization is not seen on an ECG because it is hidden by ventricular depolarization
or the QRS complex

Supplies
I. Protective padding, blanket, or mat for steel tables (stainless steel conducts electricity)
II. Alcohol or conducting gel or paste for increased skin contact
A. Note: alcohol should not be used in an emergency situation if defibrillation is a possibility
III. ECG machines that are manufactured for human use may need to be modified
A. Change the snap end to an alligator clip
1. Alligator clips should be filed or bent slightly to prevent pinching and bruising
B. For continuous monitoring, pads or wire may be used
1. Clip fur so that pad may be applied directly to the skin

Procedure
I. Ideally the animal should be in right lateral recumbency during the recording of an ECG
A. For large animals, standing position is acceptable and should be noted on the recording
B. Cats sometimes prefer crouching on the table
II. Using manual restraint, the animal should be placed on a mat or blanket with limbs separated by
paper towels or a blanket to reduce contact
III. Using alcohol or electrode gel to increase contact at the site, attach the five electrodes by alligator
clips to the skin at the following locations
A. Proximal left and right olecranons
B. Proximal left and right stifles
C. Chest lead: dorsal thorax near the seventh thoracic vertebra
1. The chest lead is not universally used; however, it may provide additional data to
diagnose right and left cardiac enlargement
IV. A three-lead ECG can be used
A. The leads are labeled RA (right front), LA (left front), and LL (left hind)
V. Ideally the animal should be drug free and without stress; however, sedation can be provided to a
fractious animal
 A. If sedation is needed to perform the ECG, the drug and dosage (in mg) should be recorded
on the ECG, because it could affect the ECG
VI. Monitor the patient's color and respiration throughout the procedure, because many patients have
compromised cardiac output and may have problems when in lateral recumbency or under stress
VII. ECG machine calibration and recording
A. A standard (in mV) should be recorded at the speed of 25 mm/sec on the strip
before the ECG
1. The mV standard is the measurement of the sensitivity of the machine (Figure 24-4)

FIGURE 24-4 Time intervals at 50 mm/sec and 1 mV standard. (Courtesy Loncke D, Rivait P, Tighe M, et al: VTII Clinical procedures handbook,

Windsor, Ontario, St Clair College of Applied Arts and Technology, Veterinary Technician Program, 2013.)
B. The paper speed should also be recorded
1. The paper speed should be changed to 50 mm/sec for lead tracings
2. A rhythm strip is run at 25 mm/sec
C. A complete ECG consists of about 30 cm (12 inches) of each lead
1. In general, six leads are recorded: I, II, III, aV , aV , and aV R L F

2. A rhythm strip consisting of 30 cm or 12 inches of lead II at 25 mm/sec

D. After completing all lead tracings, the following information should be recorded on the
tracing
1. Date of ECG
2. Patient name, client name, and species
3. Other relevant information
a. Recumbency
b. Drugs used, with dose(s) in mg
4. Name of technician
E. The tracing may then be mounted for filing

Normal Electrocardiographic Interpretation

I. A normal heartbeat should include P, Q, R, S, and T segments
A. There is a P wave for every QRS complex
B. The P-R interval is relatively constant
C. The P wave has a positive deflection (above the baseline) in lead II
D. The T segment can have a positive or a negative deflection
II. A sinus rhythm is the normal cardiac rhythm in domestic animals
III. After completion of an ECG, the veterinarian/technician can measure the complexes and compare
the measurement with normal values for each species
IV. The veterinarian/technician can also calculate the heart rate by counting the complexes in a 3-second
period
A. Most ECG paper has markings for duration of time on the top of the grid
Abnormal Rhythms
I. Sinus arrhythmia
A. An irregular ventricular rhythm that is sinoatrial in origin
B. On the ECG, the QRS-to-QRS interval varies, and there is a P wave for every QRS complex
C. Most cases of sinus arrhythmia are phasic and associated with respiration
1. The rate increases with inspiration and decreases with expiration
2. The sinus arrhythmia of respiratory origin is due to the influence of vagal tone
3. Individuals with respiratory disease tend to have augmented sinus arrhythmia
D. Most sinus arrhythmias are associated with slow rates
E. Sinus arrhythmia is normal in the dog
II. Sinus bradycardia
A. Ventricular rate is decreased
1. In dogs weighing 20 kg (45 lb) or less: a heart rate of less than 70 beats per minute
2. In dogs larger than 20 kg (45 lb): a heart rate of less than 60 beats per minute
3. In cats: approximately 100 beats per minute or less
B. Profound bradycardia will cause weakness, hypotension, and syncope
C. Etiology of sinus bradycardia
1. Enhanced parasympathetic tone due to
a. Increased inspiratory effort as a result of respiratory disease
b. Gastric irritation
c. Increased cerebrospinal fluid pressure, hypothyroidism, hypothermia,
hyperkalemia, hypoglycemia, and drug therapy
III. Sinus tachycardia
A. Sinus rhythm with an increased ventricular rate
B. A heart rate of 180 beats per minute or greater in dogs that are 20 kg (45 lb) or less
C. A heart rate of 160 beats per minute or greater in dogs that are more than 20 kg (45 lb)
D. Puppies with heart rate greater than 220 beats per minute
E. Cats with heart rate greater than 240 beats per minute
F. Etiology of sinus tachycardia
1. Pain
2. Fever
3. Anemia
4. Reduced cardiac output
5. Hyperthyroidism
6. Excitement
IV. Atrial flutter
A. Atrial flutter appears as a regular, sawtooth formation between the QRS complexes
B. Occurs when the ventricular rate differs from the atrial rate
C. Atrial flutter is the precursor to atrial fibrillation
V. Atrial fibrillation
A. No P waves are evident, and the baseline is irregular because many erratic impulses are
passing through the atrial myocardium
B. The ventricular depolarization rate is also irregular and rapid
VI. Premature ventricular contractions or complexes (PVCs)
A. Premature beats
B. The ventricle discharges before the arrival of the next anticipated impulse from the sinoatrial
node
 C. PVCs can occur at any rate but pose a greater danger when occurring with a sustained heart
rate that is tachycardic
D. The P wave is often not seen on the ECG tracing
E. A wide, distorted QRS complex is also evident
F. The beat preceding the PVC and the beat following the PVC are equal to the time of two
normal beats
G. Etiology of PVC
1. Associated with the following
a. Ventricular concentric hypertrophy or eccentric hypertrophy
b. Hypoxemic states, such as anemia, gastric dilatationvolvulus, and heart
failure
c. Acidosis
d. Drugs such as digitalis, barbiturates, and antiarrhythmic agents
e. Hypokalemia
H. Possible consequences of PVCs
1. May initiate repetitive ventricular firing in the form of ventricular tachycardia or
fibrillation
2. Cardiac output may fall if sufficient premature beats are present
3. PVCs should be treated if the patient shows signs due to dysrhythmia
VII. Atrial premature contraction
A. The P-R interval may be short, normal, or long, depending on the area of origin of the
premature beat
1. The origin could include the sinoatrial node or ectopic locations in the atria
B. The atrial premature contraction may or may not be conducted to the ventricles
1. If the beat is not conducted to the ventricles and reaches the AV node before
repolarization, premature P waves without QRS complexes will appear on the ECG
2. If depolarization is conducted through the ventricles, the QRS complex will appear
normal
VIII. Ventricular tachycardia
A. A series of four or more PVCs in sequence
IX. Ventricular fibrillation
A. The mechanical pumping of the heart is not evident on the ECG
B. The ECG has a bizarre baseline with prominent undulations
C. There are no recognizable P waves or QRS complexes
D. Unless controlled immediately, ventricular fibrillation will result in cardiac arrest
X. First-degree AV block
A. The P-R interval is longer than normal
B. This type of heart block is a result of a minor conduction defect
XI. Second-degree AV block
A. Some atrial pulses are not conducted through the AV node and therefore do not cause
depolarization of the ventricles
B. There are two types
1. Type I (Mobitz type I or Wenckebach AV block): progressive lengthening of the P-R
interval on successive beats and then P waves occurring without QRS complexes
a. P waves occurring without QRS complexes are called dropped beats
2. Type II (Mobitz type II): a constant P-R interval that is usually of normal duration
with random dropped beats
XII. Third-degree AV block
A. Also known as a complete heart block; the most severe heart block
 B. No relationship between P waves and QRS complexes; the atria and ventricles each beat
independently
XIII. Asystole
A. Cardiac arrest
1. The ECG tracing will appear as a flat line

OROGASTRIC INTUBATION
Indications
I. To remove stomach contents
II. To administer food/nutrients for orphaned or neonatal animals
III. To perform gastric lavage
IV. To administer medication or radiographic contrast material (barium)

Equipment
I. Stomach tube
A. A 12 French (F) to 18 F infant feeding tube for puppies and kittens
B. An 18 F foal stomach tube for dogs weighing more than 10 kg (22.2 lb)
C. Foal stomach tube for large dogs
II. Speculum
A. Canine speculum
B. Roll of 2-cm (2-inch)wide adhesive tape can be used
III. Adhesive tape for marking the tube
IV. Lubricant
V. Syringe containing sterile saline
VI. Syringe or funnel for administering drugs or other materials

Procedure
I. Most animals will tolerate this procedure without tranquilization; however, light tranquilization may
be required
A. Note that the use of atropine as part of a tranquilizer will slow the motility of the intestines
and should not be administered before a barium study
B. If an animal is anesthetized during this procedure, a cuffed tight-fitting endotracheal tube
should be used
1. A tight-fitting endotracheal tube will prevent aspiration of the administered material
II. Premeasure the stomach tube
A. The animal can be either standing or in sternal recumbency
B. Using the tube, estimate approximately the location of the stomach (or last rib) by holding
the tube next to the animal
1. Mark the measurement on the tube at the oral end with adhesive tape
III. Lubricate the tube
IV. Insert the speculum into the mouth and have the restrainer hold the animal's jaws shut on the
speculum
V. Pass the lubricated tube into the speculum and then advance to the premarked point on tube
A. If the tube cannot be passed to the premarked point
1. The tube is in the trachea
2. There is an obstruction in the esophagus
3. There is a volvulus, which is preventing the tube from passing
 VI. Check the placement of the tube before administration of fluids or other material
A. Note: if an animal is heavily sedated, check the tube placement by more than one method
1. Palpate the neck area to check for two hard tubes: the trachea's cartilaginous rings
and the stomach tube in the esophagus
2. Blow into the tube and listen for gurgling either on the outside of the body or within
the tube
3. Inject 5 mL of sterile saline into the tube while holding the tube toward the ceiling;
if the animal does not cough, the tube is in the esophagus
4. Smell the end of the tube for gastric odors
B. If there is any evidence that the tube is in the trachea, such as coughing, remove the tube and
reinsert it
VII. Administer materials
VIII. After administration of material, flush the tube with 6 mL of water
IX. Before removing the tube, seal the end with a thumb and then remove or kink the tube
A. This will help to prevent the leakage of the administered material and water while removing
the tube
1. The animal could aspirate the material if leakage occurs
X. Write in the patient record when and where the procedure was performed and whether any
medication was administered

Precautions
I. Administration of material into the respiratory tract, causing aspiration pneumonia
II. Esophageal trauma
III. Gastric irritation
IV. Gastric perforation

NASOGASTRIC INTUBATION
Definition
I. Placement of a tube through the external nares, the nasal cavity, pharynx, esophagus and into the
stomach

Indications
I. Used for liquid nutritional support and water administration for an extended period
A. For anorexic animals or animals too stressed to force feed
II. To administer medication or radiographic contrast medium

Equipment
I. Nasogastric feeding tube, infant feeding tube, red rubber tube, or polyurethane tube
A. The tube must be soft and flexible
1. Animals less than 5 kg (12 lb) require a 5 F feeding tube
2. Animals 5 to 15 kg (12 to 33 lb) require an 8 F feeding tube
II. Topical ophthalmic anesthetic
III. Lubricating jelly
IV. Syringe with 1 mL of sterile saline
V. Bandaging material if feeding tube is going to be used for an extended period
A. Gauze squares and adhesive tape or elastic adhesive tape
VI. Injection cap
 VII. Medication or liquid to administer

Procedure
I. Patient should be awake
II. Premeasure the tube by placing it on the side of the patient with the tip at the thirteenth rib and the
end of the tube at the nares
A. Mark the tube with a permanent marker for future reference
III. Instill 4 to 5 drops of topical anesthetic into one nostril
A. The patient may sneeze
B. Hold the patient's head toward the ceiling
IV. Wait 2 to 3 minutes and apply a few more drops of topical anesthetic to the same nostril
V. Apply a small amount of lubricating jelly to the tip of the nasogastric tube
VI. Hold the head with one hand and insert the tube into the anesthetized nostril
VII. Advance the tube approximately 20 to 25 cm (10 inches)
A. Gently rotate the tube until it is in place
VIII. Check the placement of the tube by instilling 1 mL of sterile saline into the tube
A. If the animal coughs, the tube is in the trachea
B. If the tube is in the trachea, remove the tube and start the procedure again
IX. If the tube is to remain in place for an extended time, bandage the tube in place on one side of the
patient's neck
A. Cachexic or debilitated cats will usually tolerate a tube for an extended period
B. The tube can remain in place for approximately 1 week or until the animal tolerates force
feeding or is eating on its own
X. The end of the tube should be covered with a cap to prevent the aspiration of air into the patient's
stomach
XI. Aspirate the tube before each feeding and instill 1 mL of sterile saline into the tube to check for
coughing
A. There should be negative pressure on the tube if the tube is in the stomach
XII. Before removing the tube, seal the end with a finger or thumb to prevent leakage into the pharynx
when the tube is removed
XIII. Write in the patient record the location and time of the procedure and any medications that were
administered

Precautions
I. Possible administration of materials into the respiratory tract, causing aspiration pneumonia
II. Esophageal trauma
III. Gastric irritation
IV. The procedure can be stressful to some patients
V. Contraindicated in patients with nasal tumors, esophageal disorders, or no gag reflex
VI. Possible epistaxis (nosebleed) when the tube is first inserted
VII. The tube can become obstructed by medications or nutritional supplements

CANINE MALE URINARY CATHETERIZATION

Indications
I. To collect a sterile sample of urine for analysis and culture
II. To measure urine output and drainage of urine from the urinary bladder
III. To relieve a urethral obstruction
 IV. To administer medication or radiographic contrast medium into the bladder or perform
pneumocystography

Equipment
I. Mild soap
II. Sterile polyethylene, vinyl, or rubber urethral catheter
A. These can be purchased in a variety of sizes: 3.5 F, 5 F, 8 F, and 10 F
1. Smaller and more flexible catheters cause less trauma to the urethra
B. Sterile lubricant
C. Sterile syringe(s) or sterile container to collect urine
D. Disposable gloves

Procedure
I. The patient may be in lateral recumbency or standing
II. Wearing gloves, clip the area free of long hairs and cleanse the prepuce with a mild soap
III. Select an appropriate size of sterile catheter for the patient
A. Dogs less than 12 kg: 3.5 or 5 F catheter
B. Dogs 12 to 35 kg: 8 F catheter
C. Dogs greater than 35 kg: 10 or 12 F catheter
D. Foley catheter, which has inflatable tip for long-term use
IV. Estimate the length of the catheter that will be needed to enter the urinary bladder by measuring the
catheter against the dog in the approximate position of the penis and bladder
V. A restrainer can lift the dog's upper leg away from the body
VI. Open the package containing the catheter in a sterile manner
VII. Advance the catheter out of its sterile sleeve and lubricate the end of the catheter with sterile
lubricant; the restrainer can then hold the catheter, which is still in the sterile sleeve
VIII. With one hand, retract the dog's prepuce so that approximately 1 to 2 inches (5 cm) of glans penis
is exposed
A. The glans penis may be cleansed again at this time
IX. With the other hand, insert the lubricated catheter into the urethral orifice, advancing slowly into the
bladder
A. Slight resistance or stoppage may be felt as the catheter passes the area of the ischial arch
B. If this does occur, direct the penis toward the cranial end of the animal and slightly lift the
penis off the body
X. Attach a syringe to the end of the catheter; extract urine by pulling back on the plunger
A. If there is no urine entering the catheter, advance the catheter further into the bladder
XI. After the sample is obtained, label the syringe or container with name, date, time, type of sample
(sterile or catheterized), and technician's initials
XII. An acceptable alternative is to remove the entire catheter from the package while wearing sterile
gloves
A. If this method is chosen, sterile technique must be used

Precautions
I. Urinary tract infections due to a break in sterile procedure
II. Trauma to the urethra or urinary bladder by rough handling or using incorrect catheter size

CANINE FEMALE URINARY CATHETERIZATION

Indications
I. The same as for the male dog

Equipment
I. The same as for male dog with the addition of a vaginal speculum, sterile gloves, small amount of
viscous xylocaine or 0.5% lidocaine jelly, and possibly a steel catheter
A. A human bivalve nasal speculum with a halogen bulb attached may be used instead of a
vaginal speculum
1. The use of an otoscope or a modified syringe casing as a speculum is also acceptable

Procedure
I. Patient can be in sternal or lateral recumbency if anesthetized, or standing if awake
II. The restrainer should hold the tail out of the field of view
III. For visual technique
A. Before performing the procedure, the area can be anesthetized with lidocaine gel for the
comfort of the patient
B. Check the vulva and vaginal opening using a speculum
1. Insert the closed speculum first, aiming dorsally and then cranially to avoid the
clitoral fossa (blind sac at the ventral opening of the vulva)
C. Insert lubricated sterile catheter by passing it through the speculum into the urethral orifice
and advancing the catheter into the bladder
1. The urethral tubercle leading to the urethral orifice is on the ventral surface of the
vagina, approximately 1 to 2 cm (0.5 to 1 inch) from the clitoral fossa
a. Often the urethral tubercle is white or red and appears to be puckered or in
the form of a cross
D. The catheter should be directed ventrally; if the catheter is moving in a dorsal direction, it
will enter the cervical area of the uterus and will not pass farther than approximately 4 to
5 cm (2 inches)
E. If no urine is entering the catheter, advance the catheter further into the bladder
F. Collect the urine in a sterile container and label accordingly
1. The urine can be collected in a sterile container or with a sterile syringe
IV. Touch technique (Figure 24-5)
FIGURE 24-5 Urinary catheterization of a female dog. The finger in the vestibule over the urethral orifice guides the urinary
catheter ventrally into the urethra (From Taylar SM: Small animal clinical techniques, St Louis, 2010, Saunders.)
A. Prepare the area as in the visual technique
B. Lubricate the gloved index finger of one hand and palpate the urethral tubercle
C. Pass the sterile lubricated catheter ventral to the gloved finger in the vagina, and use a finger
to guide the catheter down to the urethral tubercle and into the urethral orifice
V. A small amount of dilute povidone-iodine solution may be infused into the bladder before removing
the catheter to prevent infection

Precautions
I. The same as for the male dog

CYSTOCENTESIS
Indications
I. To puncture the urinary bladder for the purpose of obtaining an uncontaminated sample of urine for
analysis or culture
II. To relieve distention of the urinary bladder when an obstruction cannot be relieved by catheterization

Equipment
I. Large syringe (6 or 12 mL), 22-gauge needle (1 to 1.5 inch long), and isopropyl alcohol

Procedure
I. This procedure can be performed on an awake, tranquilized, or anesthetized cat or dog
 II. The animal could be in lateral recumbency with the upper leg lifted away from the body to expose
the inguinal area
A. Cats and dogs may also be in standing position or dorsal position
III. Palpate the bladder in the ventral abdominal area just cranial to the pubis to assess whether there is
urine in the bladder
IV. The location of the approximate puncture site can then be clipped and swabbed with isopropyl
alcohol
V. Try to immobilize and hold the bladder in place with one hand; use the other hand to puncture the
bladder with a sterile needle and syringe
VI. Puncture the bladder and direct the needle in a caudodorsal direction
VII. Using the syringe plunger and negative pressure, withdraw the sample of urine from the bladder
A. Do not squeeze the bladder while performing cystocentesis
B. If no fluid is obtained, remove the needle from the body and perform a second puncture
using a different needle
VIII. Withdraw the needle and syringe quickly from the body after releasing the plunger
IX. Transfer the sample to a sterile collection container and label the container with the name of the
patient, date, technician's initials, and type of sample
X. An alternate method is the pooling technique, which may help to identify the ideal location
for cystocentesis
A. The animal is in dorsal recumbency
B. A small amount of alcohol is poured on the abdomen
C. The area where the alcohol pools on the ventral midline is the ideal location for the puncture
D. Withdraw the sample as described earlier
1. In male dogs, the prepuce may be moved to one side to allow room for insertion of
the needle

Precautions
I. Urine leakage and peritonitis due to a ruptured bladder
II. Contamination of urine by blood due to a bladder hemorrhage
III. Contamination of the bladder with fecal material is possible if accidental intestinal penetration
occurs
IV. Cystocentesis is contraindicated in patients with a suspected pyometra, bladder neoplasms, and
bleeding disorders

MANUAL COMPRESSION OF THE URINARY BLADDER

Indications
I. Urine collected by manual compression is unsatisfactory for urine culture but can be used to examine
solute concentration, physical properties, and chemical constituents

Procedure
I. Locate the bladder
A. Begin palpating the abdomen starting at the last rib and move caudally; or
B. Begin palpating the abdomen slightly cranial to the rear legs
1. Begin dorsally and move ventrally
II. After palpating and immobilizing the bladder, exert moderate, gentle, steady pressure over the
bladder
III. Direct the expressed urine into a container for analysis
Precautions
I. Do not apply excessive force on the bladder, especially in cases of urethral blockage, because the
bladder might rupture

AURICULAR TREATMENT
Indications
I. Sampling of the external ear canal for yeast, bacteria, or parasites
II. The removal of cerumen, matted hair, foreign objects, and debris
III. The treatment of otitis externa
IV. Preparation of the site for surgical procedures

Equipment
I. Bulb syringe, syringe, Auriflush unit
II. Cleansing solution and waste bowls
A. Ceruminolytic agents, mild soap
III. Sterile cotton-tipped applicators, microscope slides, transport media tube for sampling
IV. Hemostats or forceps for hair removal
V. Otoscope with appropriate-sized speculum
VI. Medication
VII. Cotton, applicator sticks for cleaning
VIII. Gloves

Procedure
I. This procedure can be performed on awake patients; however, if the patient has a painful ear
infection, the patient may need to be anesthetized or heavily tranquilized before the procedure
II. Examine the ear with an otoscope
A. Check for redness, ulceration, odor, exudates, and parasites
B. Check for an intact tympanic membrane
1. If the tympanic membrane is not intact, only saline should be used to gently cleanse
the ear
2. The tympanic membrane (eardrum) appears in the lower external ear canal as a
pearly white tissue (see Figure 24-6)
FIGURE 24-6 Cross section of dogs ear structures with middle and inner ear enlarged, Colville T, Bassert J: Clinical anatomy and

physiology for veterinary technicians, ed 2, St Louis, 2008, Mosby.

III. Take samples for microbiology examination first and then samples for cytology using either sterile
cotton-tipped applicator sticks or transport media tube
IV. Remove hair for ease of cleansing
A. Pluck bunches of hair with fingers or use hemostats
1. If using hemostats, twist the handle and pull gently on the hair. It should be easy to
remove
V. If the eardrum is intact, begin using a ceruminolytic agent by dropper or syringe
VI. Gently massage the external ear canal
VII. Allow waste solution to flow into a waste bowl or into a sink
VIII. Continue to add fluid, massage and empty the ear canal
IX. Use pieces of cotton to remove the loose debris
A. Cotton-tipped applicator sticks may be used carefully to remove the debris; however, they
should be used only on the outermost areas of the ear canal and not deeply inside toward the
eardrum
X. Repeat this procedure as needed until ear is clean
XI. Continue to examine the ear with an otoscope
XII. Rinse ear with warm saline or tap water as the final step
XIII. Clean the folds of the pinna, making sure it is free of debris
XIV. Dry ear canal as much as possible
XV. When the ear is dry, instill prescribed medication
A. The medication should be massaged into the ear canal for good contact

Possible Causes of Otitis Externa

I. Parasites: Otodectes cynotis
II. Bacteria: Staphylococcus spp., Streptococcus spp., Pasteurella spp., Pseudomonas spp.
 III. Fungi: Candida albicans, Malassezia pachydermatis
IV. Foreign bodies: grass awns, dirt
V. Tumors: squamous cell carcinoma

ANAL SAC EXPRESSION

Definition
I. The anal sacs are located on either side of an animal's anus at approximately the 4 and 8 o'clock
positions
II. The anal sacs are filled with malodorous secretions and should normally be expressed when the
animal defecates
III. This procedure is commonly performed on dogs, rarely on cats

Indications
I. To decrease irritation to the animal caused by distention or inflammation
II. To instill medication into diseased anal sacs
III. Removal of material from anal sacs

Procedure
I. The dog may have to be muzzled and/or securely restrained
II. There are two methods for anal sac expression
A. External
1. Using rolled cotton over the dog's anus, apply pressure in a medial and slightly
dorsal direction of the external anus
2. This method does not guarantee full expression of anal sacs
B. Internal
1. Insert a gloved, well-lubricated index finger into the anus
2. With cotton covering the sac, gently squeeze together index finger and thumb to milk
contents of the anal sac toward the medial anus
3. After examining the contents of secretions, roll the glove over the cotton, remove
from the hand, and discard
a. Normal anal sac material should contain granular, brown, malodorous
material

Precautions
I. Rupture of abscessed anal sac
II. Perforation of rectum

ENEMAS
Definition
I. An enema is the infusion of fluid into the lower intestinal tract through the anus
II. Enemas are used to remove fecal material from the colon

Indications
I. To prepare for radiographs with or without contrast medium involvement
II. To irrigate the colon of a patient who has been poisoned
III. To relieve constipation
Procedure
I. Sedation or anesthesia may be needed in cases of severe blockage or fractious animals
II. An abdominal radiograph should be completed to rule out perforation or presence of foreign body
III. Use an enema container with a rounded, soft, pliable piece of connected tubing
IV. Place the animal in sternal or lateral recumbency, preferably on a tub table
V. Put on examination gloves
VI. Place the enema preparation into the enema container
A. Examples of enema preparations
1. Mild soap and water
2. Saline for irrigation
3. Commercial enema preparation
B. Hyperphosphate enema solutions should not be used in cats or small dogs
1. These solutions may cause acute collapse associated with hypocalcemia
VII. Lubricate the end of the flexible tubing
VIII. Insert the tip of the enema tubing to the colorectal junction
IX. Place the enema container above the animal so that the flow of solution into the animal is aided by
gravity
X. More than one enema may be required to adequately evacuate the animal's bowels
XI. Do not continue to administer enemas if there is no sign of fecal material
XII. Do not proceed with enema if there is evidence of abdominal pain that could be associated with
intestinal perforation or obstruction

Precautions
I. Rupture of the colon
II. Leakage of enema fluid into peritoneal cavity through already ruptured intestinal tract
III. Hemorrhage in cases of ulcerative colitis
A. Enemas are contraindicated in cases of ulcerative colitis because they may increase bleeding

OPHTHALMOLOGY (Table 24-1)

Anatomy (Figure 24-7)

TABLE 24-1
Conditions of the Eye

Common breeds
Condition and etiology Description Signs Treatments
affected

Ophthalmia neonatorum Infection of eye in Acute purulent Flushing of eye and oral Newborn animals
(congenital) newborn discharge, antibiotics
animals swollen eyes

Microphthalmia (inherited Failure of eye to Eyeball decreased in None Pekingese,

defect) reach its size in all poodle,
 Common breeds
Condition and etiology Description Signs Treatments
affected

normal size diameters miniature

schnauzer,
collie,
Chihuahua,
and canary

Entropion (inherited) Turning inward of Eyelashes scratch Surgical removal or eye Chow chow, shar-
eyelid, the cornea, tuck pei
usually the causing
lower lid ulceration

Ectropion (inherited) Outward turning Dryness of eye Surgery or eye tuck Bloodhounds,
of eyelid, American
exposing Eskimo,
conjunctiva American
cocker
spaniel,
basset
hound, and
Saint
Bernard

Hypertrophy/eversion of Glandular tissue Excessive tearing, Antibiotics, steroids, and Spaniels, Boston
the third eyelid, or projects mucoid repositioning surgery terrier, pug,
cherry eye beyond the discharge, if needed and beagle
(inherited, haw corneal erosion,
conformation of eye) (membrane and possible
nictitans) and rupture of the
possibly anterior
lacrimal chamber and
gland iris prolapse

Distichiasis (autosomal Second row of Sometimes Plucking or epilation of English bulldog,

recessive trait) eyelashes, ectropion too; the extra eyelashes, cocker
usually ulcerations of cryosurgery spaniel, bull
incomplete, the cornea terrier, and
on upper or
 Common breeds
Condition and etiology Description Signs Treatments
affected

lower eyelid poodle

Trichiasis (trauma, Ingrowing hairs Scratches of cornea Removal of problem hairs Poodle
inherited) Eyelashes as for distichiasis
assume an
abnormal
deviation

Hordeolum/stye Inflammation of Usually involving Antibiotics Any breed

Staphylococcus spp. the hair the gland or
(bacterial infection) follicle or eyelid;
sebaceous erythematous,
gland swollen,
cystlike lesion

Strabismus types: Squinting or Congenital or None Congenital in the

crossing of acquired Pekingese,
the eyes; because of pug, Boston
Convergent: medial
movement malfunction injury, terrier, or
Divergent: outward of the muscle cellulitis, or Chihuahua
movement (inherited that moves sinusitis
or congenital)
the eye

Keratoconjunctivitis sicca Decrease in tear Conjunctivitis; Diagnosis by Schirmer Bulldogs, West

or "dry eye" (inherited production sticky, stringy tear test; treat with Highland
or drug induced) and corneal discharge; red, 0.2% cyclosporine white
film dull eyes; dry ointment terriers,
nostrils Lhasa apso

Uveitis (Brucella spp., Inflammation of Conjunctiva and Steroids, nonsteroidal No specific breed
adenovirus, the middle lids swollen, antiinflammatory
neoplasm, trauma, or vascular layer corneal edema, drugs (NSAIDs),
keratitis) of the eye; miotic pupil, mydriatics, and
includes iris, swollen and
ciliary body, discolored iris
 Common breeds
Condition and etiology Description Signs Treatments
affected

choroids, and atropine

uvea

Pannus (autoimmune Chronic superficial Cornea red and Lifelong steroids German
disease) keratitis irritated, shepherds
discharge, and
itchy eyes

Keratitis or corneal ulcer Corneal Can be very deep or No steroids; antibiotics, No specific breed
(scratches or abrasion inflammation superficial; red, atropine only if pupil
due to bacterial, viral or ulcer swollen is miotic; soft contact
infections, or trauma) conjunctiva; lens acting as a
scratching; bandage or barrier to
blepharospasm further infection;
; discharge conjunctival flap for
2 days, depending on
how deep the ulcer is
in the eye tissue

Glaucoma (inherited or Increase of Large, swollen Mannitol, antiglaucoma Bassett hound,

secondary infection) intraocular eyeball; painful medications, American
(acute or chronic) pressure due pilocarpine (primary and English
to decreased glaucoma cases cocker
draining of only), possible spaniel,
the aqueous enucleation Siberian
humor from husky,
anterior poodles
chamber

Dermoid cyst (congenital) Embryological Hair growing on Surgery No specific breed

defect; piece cornea after
of skin or newborn's eyes
tissue that have opened
carries hair
root has
attached to
the cornea
 Common breeds
Condition and etiology Description Signs Treatments
affected

and/or
conjunctiva

Cataract (inherited) Opacity of the lens Cloudy/gray lens; Surgical removal of lens Any breed
of the eye blindness

Nuclear sclerosis Normal aging of Cloudy/gray eye No treatment required; Any breed
(inherited) eye animal still has
vision

Progressive retinal atrophy Degeneration of Starts with poor Vitamin A in early stages English cocker
(autosomal recessive rods and night vision; to slow down spaniel,
gene, sometimes cones sluggish progression poodle,
secondary to reaction of collie, and
cataracts) pupils to light; sheltie; very
progresses to common and
blindness can affect
many breeds

Anterior uveitis (feline Inflammation of Blepharospasm, Steroids, NSAIDs,

infectious peritonitis, the uvea, epiphora, antibiotics, atropine
feline leukemia virus, including iris swollen lids,
feline and ciliary corneal edema,
immunodeficiency body miotic pupil,
virus, toxoplasmosis, discoloration of
or leptospirosis) the iris
FIGURE 24-7 Sagittal section of eye. Colville T, Bassert J: Clinical anatomy and physiology for veterinary technicians, ed 2, St Louis, 2008, Mosby.

I. Knowing the anatomical features of the eye is important in ophthalmology

II. Such structures as the conjunctiva, lens, ciliary body, cornea, sclera, choroids, retina, vitreous humor,
aqueous humor, iris, and pupil all contribute to the animal's ability to see objects clearly (see Chapter
1)
III. Feline and canine eyes are different
A. Feline differences
1. Tapetum lucidum
a. Iridescent epithelium of the choroid of the feline eye
b. This epithelium causes their eyes to shine in the dark
2. Pupil shape is oval rather than round
3. Cats do not have true eyelashes; their hair grows to the edge of the eye

Tears
I. Formation of tears (Figure 24-8)
FIGURE 24-8 Lacrimal Apparatus. Tears produced by lacrimal gland flow down surface of eye and drain into lacrimal puncta.
From there, they pass into the lacrimal sac and down nasolacrimal duct to nasal passage. Colville T, Bassert J: Clinical anatomy and

physiology for veterinary technicians, ed 2, St Louis, 2008, Mosby.

A. Lacrimal glands produce moisture (tears), and the tears empty into a conjunctival sac and
flush over the eye
B. Tears leave the eye by moving into the lacrimal puncta at the medial canthus
C. Tears then move through the lacrimal sac, which drains into the nasolacrimal duct
D. The nasolacrimal duct empties the tears into the nose or the tears are swallowed
II. Functions of tears
A. Wash out foreign bodies
B. Lubricate and moisten cornea
C. Tears are necessary for the proper refraction of light on the cornea

Formation of the Aqueous Humor

 I. Maintains intraocular pressure and is one of the most important structures in the eye
II. Comes from the ciliary processes
III. Remains in constant amount
IV. Leaves eye via the intrascleral plexus
V. Carries waste products of the lens and corneal metabolism
VI. If the aqueous humor increases in pressure, it could lead to glaucoma

Medical Terminology
I. Proptosis: forward displacement or bulging of the eye
II. Epiphora: overflow of tears
III. Conjunctivitis: inflammation of the conjunctiva or tissue lining the eyelid
IV. Miotic: drug that makes pupils decrease in size (e.g., pilocarpine)
V. Mydriatic: drug that make pupils increase in size (e.g., 1% tropicamide or 2.5% phenylephrine)
VI. Medial canthus: area of the eye closest to the nose, at the junction of the eyelids
VII. Lateral canthus: area of the eye closest to the ears, at the junction of the eyelids
VIII. Ophthalmic drops: aqueous solution that lasts a short time on the eye
IX. Ophthalmic ointments: thicker solutions that last longer than drops on the eye
X. Artificial tears: generally a solution made of methylcellulose, which lubricates the eye

Therapeutic Techniques
I. Restraint techniques
A. To retract the third eyelid while restraining patient
1. Feline: shake head slightly
2. Canine: shake head or tip head up and down
B. Be careful to perform minimal restraint around head area
1. If pressure is applied to the external jugular vein, it may change the results of eye
pressure tests
C. Use one hand to control the muzzle by wrapping fingers around mandible and maxilla or
top of muzzle
II. Examination
A. Evaluate head symmetry
B. Check for drooping eyelids and discharge
C. Check pupillary light reflex by quickly shining a strong light near the eye
1. It is possible to have pupillary light reflex and be blind
D. Check to see if patient will follow hand or object
1. For feline patients, drop a cotton ball a few feet above their heads from behind them.
This will ensure that the cat is following the object and not reacting to air flow
movement
III. Ophthalmoscopy
A. Examining the eye using an ophthalmoscope
IV. Schirmer's tear test
A. Used to diagnosis keratoconjunctivitis sicca (KCS) and to assess the amount of tear
production in each eye
B. Patient should not be given any drugs 1 to 2 hours before test
C. Wipe excess mucus from eye with dry swab
D. Topical ophthalmic anesthetic can be used to anesthetize the cornea
E. Open prepared packaged sterile strips
 F. Using sterile technique, fold strip at a 90-degree angle and insert notched end under lower
eyelid
G. Hold strip in eye for 1 minute and measure moisture on strip using the scale on package
1. Less than 10 mm moisture = KCS, feline
2. Less than 15 mm moisture = KCS, canine
3. A range of 18 to 25 mm is the normal amount of moisture
V. Corneal staining
A. Performed to determine the presence or location of cornea ulcers or to check the patency of
the nasolacrimal duct
B. Moisten sterile fluorescein strip with ophthalmic irrigating solution or artificial tears solution
C. Lift the upper eyelid
D. Place the moistened strip under the eyelid on sclera of eye for 1 to 2 seconds
E. Remove strip
F. Flush the eye with ophthalmic irrigating solution
G. Examine the cornea in a partially dark room with either an ophthalmoscope or a Wood's
lamp, checking for bright green dye in ulcerated area
H. Observe the external naris of the tested eye for green dye
1. If fluorescein dye is present, it indicates patency of the nasolacrimal duct
I. Continue to flush until the eye is free of stain
VI. Rose bengal stain can also be used to stain devitalized epithelial tissue and to diagnose KCS
VII. Tonometry (Figure 24-9)

FIGURE 24-9 Cat with severe glaucoma. Courtesy Monica Tighe St. Clair College, Veterinary Technician Program, Windsor ON, 2013.

A. Measures intraocular pressure for glaucoma

B. Anesthetize cornea using topical anesthetic
C. Tilt animal's snout upward toward ceiling and retract lower eyelid with finger of one hand
D. Place tonometer vertically, resting on cornea of the eye
1. There are several types of tonometers
 a. Schitz; manual
b. Tono-Pen; digital readout and hand held (most common)
2. Use the average of three readings for each eye
3. There should be a difference of no more than 1 unit between the three readings
E. The same person should perform this procedure for all visits to ensure consistent and
accurate readings
F. A normal reading is 15 to 25 mm Hg
VIII. Gonioscopy
A. Using an ophthalmoscope and magnification lens to examine the iris angle and anterior
chamber
B. Examination for glaucoma and neoplasm
C. A very specialized procedure
IX. Lacrimal flushing
A. Anesthetize animal or apply topical anesthetic
B. Equipment required: cannulas (21 to 22 gauge) with 6 mL of sterile saline, gauze square,
and strong overhead lighting
C. Find the lacrimal puncta near the medial canthus of the eye (usually they are pigmented)
D. Place the cannula in the lower punctum, positioning the cannula toward the nose and inject
sterile saline
E. Place one finger over the upper punctum and allow saline to exit via the nasolacrimal duct
through the nostril
F. Repeat this same procedure in the upper lid punctum while holding off the lower lid's
punctum
G. Flush the puncta of both eyes
X. Surgical preparation
A. Instill ointment in the eye to prevent hair from entering eye
1. Exception: for perforating injuries, do not use ointments
a. Ointments can recede into anterior chamber of the eye and create serious
problems
B. Clip the hair around the eye only; may remove eyelashes
C. Chlorhexidine gluconate or a mild solution of Betadine (povidone-iodine) (1 part Betadine to
20 parts saline) can be used to cleanse the area
1. Do not use alcohol or pHisoHex, because they are toxic to corneal epithelium

DERMATOLOGY
Anatomy
See Chapter 1 and Figure 24-10
FIGURE 24-10 Canine Skin. Cubed section of canine skin and underlying subcutaneous tissue. (From Colville T, Bassert J: Clinical

anatomy and physiology for veterinary technicians, ed 2, St Louis, 2008, Mosby.)

Examination of the Skin

I. Examination should be performed in a well-illuminated area
II. A magnifying lens should be used to examine skin lesions
III. Part the hair or clip fur to see underlying lesions
IV. Check the entire coat
V. Examine the mouth, sides of mouth, and foot pads for hidden lesions

Primary Lesions
I. Primary lesions arise from normal skin
II. Primary lesions exhibit the initial pathological changes
III. These lesions should be used for skin biopsy and histological tests

Secondary Lesions
I. These lesions develop from preexisting skin lesions (primary lesions)
II. They always arise from previous pathological changes rather than from normal skin

Dermatology Terminology
See Table 24-2.

TABLE 24-2
Dermatology Terminology
Lesion Description

PRIMARY LESION TERMINOLOGY

Macule Erythematous, not raised or depressed, visual change in skin, < 1 cm

Papule Erythematous, circular, elevation of skin, < 0.5 cm

Nodule Small node, solid elevation, extends into deep layers of skin, > 1 cm

Tumor Swelling or mass of varying size

Pustule Small, circumscribed, pus-filled elevation of skin

Vesicle/bulla Vesicle: small blister filled with clear fluid, < 0.5 cm
Bulla: large blister filled with fluid, > 0.5 cm

Wheal Hives; raised, flat topped, redder or paler than surrounding skin, usually
accompanied by itching

Plaque Flat-topped, solid elevation with alopecia and erythema

SECONDARY LESION TERMINOLOGY

Lesion Description

Scale Dandruff; accumulation of loose epidermis

Epidermal collarette Circular or semicircular accumulation of scale on skin surface

Erosion/excoriation Superficial defect caused by partial loss of epidermis

Ulcer Defect of skin or mucous membranes due to loss of epidermis and dermis

Crusts or scabs Formed from dried exudates on the surface of a skin lesion

Hyperpigmentation/hypopigmentati More/less than normal color in skin

on

Lichenification Thickening or hardening of the skin

Scar Hard plaque of dense fibrous tissue

Hyperkeratosis Extreme increase in the thickness of the corneum of the skin

Fissure Deep defect (usually in a foot pad); a crack-like sore

Comedo Blackhead; plug of keratin and dried sebum in a hair follicle

Lesion Description

Cyst A closed sac or pouch containing fluid or semisolid material

Hyperhidrosis Excessive sweating

Alopecia Loss of hair

Erythema Redness of skin

Hot spot/acute moist dermatitis Bacterial skin disease

Types of Shampoo
There are many commercial brands of shampoo used for a variety of conditions. Table 24-3 lists the most
common dermatological conditions and the most common shampoos used to treat those conditions.

TABLE 24-3
Common Shampoos

Benzoyl
Povidone-iodine
Sulfur Salicylic Coal/tar peroxide Chlorhexidine
1%
2.5%

Seborrhea
sicca

Seborrhea
oleosa

Keratolytic

Keratoplastic

Antipruritic

Antifungal

Antiparasitic

Antibacterial
 Benzoyl
Povidone-iodine
Sulfur Salicylic Coal/tar peroxide Chlorhexidine
1%
2.5%

Use Flushes Allergic Not for use on Hot spots Hot spots Short residual
folli contact cats; Skinfol Superficial May cause
cles dermatitis allergic d folliculitis contact
and contact dermati Not inhibited by dermatitis
calluses dermatitis tis organic debris, and skin
Deep such as dirt, irritation
pyoder scales, or crusts Staining
mas
May
bleach
fabrics
Common Dermatological Conditions
I. Bacterial
A. Pyodermas and abscesses are the most common bacterial infections
1. Staphylococcus spp. are the most common organisms found on canine skin
B. Most bacterial infections are secondary to another disease (e.g., parasitism, allergies,
endocrine disorders, immunological diseases)
C. Signs include yellow pustules; erythematous lesions; ulcerations; dry, crusted areas with
alopecia; lesions are often round
D. Diagnosis
1. Culture and sensitivity
2. Sterile swab sample and Gram stain
3. Fine-needle aspiration of pus from lesion
E. Treatment after diagnosis includes:
1. Clipping the area and washing with antibacterial soap or shampoo
a. Careful, thorough drying
b. Application of antibacterial ointments
2. Oral antibiotics may also be prescribed with nutritional supplements
II. Fungal (ringworm)
A. Etiology is generally two genera of fungi: Microsporum canis and Trichophyton spp.
B. Ringworm is more common in young canines
C. Fungi live in hair and nails
D. Signs include circular patches of alopecia, the center of which may be dry and crusty
1. The head and legs of the patient are the most commonly infected
E. Diagnosis
1. The appearance of the lesions and patient history
2. Wood's lamp test (ultraviolet, short wave) can be used to diagnose Microsporum spp.
only
3. Most reliable test is to culture the fungi found on infected areas
a. Fungassay (Synbiotics Corp., San Diego, CA) is a special culture medium
used for fungus
b. Swab the lesion with 70% alcohol to remove secondary bacteria
c. Take hair and skin debris using sterile forceps from an area at the margin of
the suspected lesion and imbed them into the small bottle of medium
d. Label the bottle with the patient's name, date, and location of lesion
e. Place the bottle in a dark area at room temperature and check for growth
daily
f. The cap should be slightly loose to allow for aerobic conditions
g. A positive sample consists of fluffy, white fungi and a change in color of the
medium from orange to red
F. Treatment
1. Clip the hair around the lesion, and apply a fungicidal shampoo to entire animal
2. Fungicidal ointment can also be applied to the infected area
3. Griseofulvin or ketoconazole orally may also be prescribed
4. Treatment with oral antifungals and application of ointments must be continued for
several weeks to be effective
G. Zoonoses
1. Ringworm is zoonotic to humans and especially small children
 2. If ringworm is suspected, the animal should be treated immediately and children
should be kept away from the animal until the infection is under control
III. Allergic skin diseases
A. Etiology is usually due to a hypersensitive reaction to allergy-causing substances. These
substances are known as allergens or antigens
B. Small animals can develop allergies at any age
C. Allergens include flea bites, food, mold, pollen, grass, certain soaps or shampoos, insect bites
(bees, wasps, yellowjackets)
D. Signs include pruritus; red, moist patches (called hot spots); pus; and dried crusts
E. Location of lesions
1. Flea allergies are most common dorsally near base of tail
2. Dog's face and front legs are more often affected by pollen and food allergies
3. Contact allergies are seen mostly in areas of skin with the least coverage of hair, such
as the armpits, chin, elbows, hocks, foot pads, and genitals
4. Dogs allergic to flea collars will show irritation around the neck area, where the
collar contacts the skin
F. Diagnosis
1. History
2. Positive response to treatment
3. Intradermal skin testing or serum allergy testing
4. Biopsy
G. Treatment
1. Drugs: antihistamines, corticosteroids to decrease the pruritus
2. Avoidance of the allergen
a. This may be the least practical treatment
3. Immunotherapy
a. Gradual exposure of the allergen in increasing doses
b. This should be considered only for long-term patients
c. This can be used for patients that are intolerant of glucocorticosteroid side
effects
IV. Parasites
A. Examples
1. Fleas are the most common parasite
a. Itching, alopecia, crusting of the skin, flea dirt
b. Flea dirt will turn red when exposed to water
2. Sarcoptic mange: itchy areas most commonly around the ears, front legs, chest, and
abdomen
3. Demodectic mange: nonitching areas around the face and front legs with red and
scaly ringworm-like lesions
4. Ear mites (Otodectes spp.) cause scratching and red, irritated ears
5. "Walking dandruff" (Cheyletiella spp.): small, white insects found on hair
6. Ticks
B. Diagnosis
1. History of contact
2. Appearance
3. Skin scraping
a. A sterile blunt scalpel blade with a small amount of mineral oil is used to
harvest hair and debris from several lesions
 b. If demodectic mange is suspected, pinch a fold of skin and scrape the fold
until there is a slight oozing of blood
(1) Because Demodex are burrowing mites, pinching a fold of skin
brings the mite to the surface
c. If Sarcoptes is suspected, the entire lesion should be scraped
(1) For Sarcoptes, at least 8 to 10 lesions should be tested to diagnose
the infestation
d. The harvested sample should be examined under a microscope immediately
after sampling is completed
4. Cellophane tape sampling
a. A piece of clear tape is used to collect the parasite
b. The tape containing the sample is applied to a microscope slide for
microscopic examination
C. Treatment
1. Clip the entire hair coat for ease of treatment
2. Medicated shampoo may be used for several weeks
a. If using shampoo, follow directions and leave shampoo on animal for
prescribed length of time
3. Dips, shampoos, dermal applications, or oral flea medications are also commonly
used
V. Hormonal
A. Hormonal skin conditions are difficult to diagnose
B. Etiologies include hypersecretion or hyposecretion of hormones from the thyroid, adrenal, or
pituitary gland
1. Ovaries or testicles may also cause a change in skin condition
C. Signs
1. Changes to the skin and hair coat on the lateral sides of the body
a. The skin is often dark in color and thicker than normal
D. Diagnosis
1. Blood tests
VI. Genetic
A. Canine seborrheic complex
B. A defect in the keratinization of the skin that is associated with increased scale formation,
increased or decreased greasiness of the skin, and secondary inflammation
1. Seborrhea sicca: dry skin with diffuse scaling and accumulation of white to gray
scales, alopecia, erythema, and inflammation
a. Dry, dull hair coat
b. Common in Irish setters, German shepherds, dachshunds, and Doberman
pinschers
2. Seborrhea oleosa: excessive greasiness of skin with diffuse scaling, alopecia,
erythema, and inflammation
a. Brownish flakes adhere to skin
b. Coat has a distinct odor and is greasy to touch
c. Often associated with otitis externa
d. Cocker spaniels, shar-peis, West Highland white terriers, and basset hounds
are predisposed to this skin condition
C. Diagnosis
1. History and physical examination
2. Systematic elimination of possible underlying etiologies
 a. Skin scraping, biopsy, nutritional changes, bacterial cultures, blood
chemistry panels, hormone analysis
D. Treatment
1. Medicated shampoos daily and then every 2 weeks
2. Possibly corticosteroids to relieve pruritus and erythema
a. Antibiotics to control secondary infections
b. Dietary supplements to increase fatty acids
c. Vitamin A supplements to decrease flaking and scaling of the skin

WOUND MANAGEMENT
Wound Contamination Versus Infection
I. All wounds are contaminated; however, a contaminated wound elicits no immune response from the
host body
A. A surgical wound is considered contaminated by microbes on the tissue and surrounding
area
II. Infection is the term used for a wound where microorganisms are invading tissue and therefore
eliciting an immune response from the host body
A. A wound is considered infected if the patient is presented for treatment more than 12 hours
postinjury
1. Signs of infection can include edema, pus, fever, neutrophilia, pain, color change,
exudates, and odor
III. A contaminated wound can become infected from the addition of foreign material in the wound,
necrotic tissue, or excessive bleeding

Wound Healing
I. The four phases of wound healing are the inflammatory phase, the debridement phase, the repair
phase, and the maturation phase
A. Inflammatory phase: begins directly after the injury
1. Vasoconstriction is followed by vasodilation to control hemorrhage and then produce
a clot
2. The blood clot will dry and form a scab, which allows healing to begin
B. Debridement phase: begins approximately 6 hours postinjury
1. Neutrophils and monocytes travel to the site to remove foreign material, bacteria,
and necrotic tissue
2. An exudate is formed from fluid and white blood cells
C. Repair phase: begins 3 to 5 days postinjury and depends on the debridement stage and the
removal of foreign material in the wound
1. The debridement and inflammatory phases, or the first 3 to 5 days postinjury, can
also be called the lag phase
a. The lag phase is characterized by minimal wound strength
2. In the repair phase, fibroblasts produce collagen that, after maturation, will become
scar tissue and strengthen the wound
3. Granulation tissue starts to appear after formation of new capillaries, fibroblasts, and
fibrous tissue
a. Granulation tissue appears under the scab as red, fleshy material
4. Epithelialization, or the formation of new epithelial tissue, on the wound surface
becomes visible 4 to 5 days postinjury
 a. Epithelial cells at the edge of the wound divide and migrate across the
granulation tissue
b. The new tissue is only one cell thick; however, over time it thickens through
the formation of more cell layers
5. Wound contraction, reducing the size of the wound, occurs 5 to 9 days postinjury
D. Maturation phase: the final phase, this is the longest phase
1. During this phase, wound strength increases to its maximum level because of
remodeling of the collagen fibers and fibrous tissue
a. Cross-linking increases and improves wound strength
2. The scar gradually disappears because of the increased number of capillaries in the
fibrous tissue
3. This phase may continue for many years
E. Wound healing is a series of overlapping events; more than one phase may be occurring at
one time

Types of Wound Healing

I. Primary or first-intention healing
A. Characterized by noncomplicated healing
1. Examples: small lacerations, minor wounds, and clean wounds
2. In the case of fractures, using pins or plates
II. Second-intention healing
A. Wounds that are left open and allowed to heal from the internal to external areas
1. Examples: larger wounds, infected wounds
2. Healing of fractures through the normal formation of a callus
III. Third-intention healing
A. Initial second-intention healing (open wound) followed by surgical repair
1. Examples: severely contaminated wounds, very large wounds

Wound Closure
I. Primary closure with primary intention
A. Usually surgical wounds that are closed with staples or sutures
B. Small, fresh, clean wounds
II. Delayed primary closure
A. Wounds older than 6 to 8 hours that have some contamination
B. This type of wound is left open for 2 to 3 days to allow for drainage and reduction of
infection
C. After the infection has been drained, the wound is surgically closed
III. Secondary closure (also known as third-intention healing)
A. Wounds older than 8 hours, infected and/or necrotic, or that have failed at primary closure
B. Granulation tissue is allowed to form and the wound either is allowed to granulate in
or is closed by primary closure methods
IV. Second-intention wound healing (Nonclosure)
A. Wounds older than 8 hours that are infected and/or necrotic
B. This type of wound is allowed to heal by granulation tissue formation and epithelialization
C. This often takes many days to heal and requires ongoing treatment protocols
D. This may lead to scarring, contracture, and loss of function

Wound Treatment
I. First aid
A. Protection of the wound, either by bandaging or by applying a makeshift splint, is important
II. Wound evaluation
A. Control of hemorrhaging should be the first priority, followed by an evaluation of the wound
for possible contamination and infection
B. The injury should then be assessed by obtaining a history and checking the location and size
of the wound
III. Clipping, scrubbing, and wound lavage
A. All wounds should be clipped before treatment
1. A sterile lubricant can be put into any open wounds to avoid further contamination
of the site by loose hair
2. Ophthalmic ointment may be applied in the eye before clipping and cleaning for
protection of the cornea and globe
B. The outer edges of the wound can then be gently scrubbed using a detergent/antimicrobial
surgical scrub
1. Povidine-iodine or chlorhexidine agent is recommended
C. Wound lavage is most effective when at least 7 pounds per square inch (psi) of pressure are
used
1. Equipment
a. A 35- to 60-mL syringe with an 18-gauge needle attached
b. Spray bottle
c. Lavage solutions include
(1) Isotonic saline, LRS, or plain Ringer's solution
(2) Hydrogen peroxide
(a) Its foaming effect can damage tissues
(b) Is not antimicrobial, just sporicidal
(c) Should be used only for first-time irrigation of dirty
wounds
(d) Should not be used under pressure because of foaming
(3) Chlorhexidine diacetate solution (0.05%)
(a) Broad-spectrum antimicrobial
(b) Antimicrobial effect is immediate with a lasting residual
effect
(c) Not inactivated by organic material
(4) Povidone-iodine solution (1% to 2%)
(a) Broad-spectrum antimicrobial
(b) Antimicrobial effect lasts approximately 4 to 6 hours
(c) It is inactivated by blood, exudates, and organic material
(d) The detergent form is not recommended for wounds,
because it causes irritation and potentiation of wound
infections
IV. Debridement
A. Debridement is the removal of necrotic tissue
B. Necrotic tissue must be removed for new tissue to migrate over the wound
1. Necrotic tissue is also considered a growth medium for bacteria, so its removal
reduces the chances of infection
C. Debridement is considered complete when the wound is free of necrotic tissue
1. The wound is then considered a clean wound
 D. Mechanical debridement includes the use of surgical instruments, dry-to-dry dressings, wet-
to-dry dressings, and irrigation
E. Nonmechanical debridement is generally the addition of enzymatic agents or chemicals to
the wound
1. Both mechanical and nonmechanical methods may be used to treat a wound
F. The procedure should be performed aseptically
V. Drainage
A. Drains are implanted in a wound to help relieve the buildup of air or fluid
1. The drain will reduce the possible formation of seromas, hematomas, tissue pockets,
or dead space
B. Drains are usually indicated
1. For treatment of an abscess
2. When foreign material in a wound cannot be removed
3. When contamination is probable
4. When necrotic tissue cannot be excised
5. For prevention of the creation of dead space and to remove fluid or air after a
surgical procedure
C. Penrose drains are used most commonly
1. They are composed of soft, latex rubber
2. Fluid flows through the lumen of the drain and around the drain
3. Penrose drains should not be left in place for longer than 3 to 5 days

BANDAGING
Types of Bandages
I. Bandages have up to three layers: primary, secondary, and tertiary
A. Primary layer is next to the wound
B. Secondary layer is present to absorb exudates and provide padding
C. Tertiary layer is the outer layer, which is used for support
II. Primary layer material
A. Adherent bandages are used to remove necrotic tissue and wound exudates when they are
taken off
1. These bandages (usually sterile gauze) are used in the very early stages of wound
healing
a. Dry-to-dry dressings are used when loose necrotic tissue is evident
(1) Dry sterile gauze is placed over the wound with an absorbent wrap
holding it in place
(2) Bandage removal may be painful because dead tissue is adhered to
the bandage
b. Wet-to-dry dressings are used for wounds with dried or semidry exudates
(1) The bandage is applied wet, and it absorbs the material from the
wound
(2) The exudate then adheres to the bandage and is removed when the
bandage is removed
(3) Saline or chlorhexidine can be used to moisten the bandage
c. Wet-to-wet dressings are used on wounds with large amounts of exudates
and transudates
(1) Wet dressings tend to absorb fluid easily
 (2) Wet dressings can be used to heat the wound, which will enhance
capillary action and therefore increase the drainage of the wound
(3) These bandages are removed wet and therefore cause less pain on
bandage removal
(4) The negative aspect of this type of bandage is that there is little
wound debridement because of the decreased adhesion to necrotic
tissue
B. Nonadherent primary layer
1. Used when granulation tissue is starting to form
2. Commonly used to minimize tissue injury during bandage changes
3. Moisture-retaining bandages maintain a warm and moist environment, improve
epithelialization, and assist in selective debridement
4. There are many commercial products on the market
5. Semiocclusive and occlusive are types of nonadherent primary layers
a. Semiocclusive bandages are permeable to air and fluid and allow exudate to
be absorbed by the secondary layer
b. Occlusive bandages are impermeable to air and retain moisture
III. Secondary layer provides extra absorbency to draw fluids away from the wound and adds padding
for support
A. Generally, gauze bandaging is used, such as Kling (Johnson & Johnson, Skillman, NJ)
IV. Tertiary layer holds the primary and secondary layers in place
A. Generally made up of adhesive tapes, elastic bandages, Vetrap (3 M, St. Paul, MN), and a
conforming stretch gauze (Conform; Kendall, Mansfield, MA)
V. Medical-grade honey can also be used to help wounds heal
A. Honey has both bacteriostatic and bacteriocidal properties that help with antimicrobial
resistance
B. It has been used for many centuries as a natural wound salve

Head and Neck

I. Reasons for bandaging
A. Postocular surgery
B. Repair of an aural hematoma
C. Ear surgery
D. To secure a jugular catheter or pharyngostomy tube
II. Precautions
A. The bandage should be frequently checked postoperatively because edema, which could be
life threatening, may occur
B. Respiration and mucous membrane color must be monitored closely
1. The bandage should be loose enough to enable two fingers to fit under the bandage
2. If there are any changes in respiration, the bandage should be loosened or changed
immediately
C. If the animal tries to remove the bandage, an Elizabethan collar can be used for restraint

Thorax
I. Reasons for bandaging
A. To secure chest drains
B. To protect large thoracic wounds
C. Spinal surgery
 II. Precautions
A. If respiration becomes impaired, the bandage should be removed or cut to loosen it
immediately

Abdomen
I. Reasons for bandaging
A. To secure a gastrostomy tube
B. After a radical mastectomy
C. For extensive wounds or dissection of the abdominal region
II. Precautions
A. Be careful not to incorporate the prepuce when applying the bandage to male dogs, because
this can interfere with urination
B. The bandage should also be kept clean and dry from urine and feces

Limbs
I. Reasons for bandaging
A. Immobilization of fractures
B. Wound protection
C. Stabilization for fluid therapy
II. Most common type: Robert Jones or Modified Robert Jones pressure bandage
A. A Robert Jones bandage can be used to temporarily stabilize fractures before surgical repair
B. This bandage consists of several layers of rolled cotton compressed tightly with elastic gauze
and elastic tape
C. The underlying layers of cotton prevent constriction of the limb
III. Precautions
A. Never bandage only the upper portion of a limb; the entire limb should be bandaged
B. This allows for even distribution of pressure along the limb and maintains venous return
from the paw
C. The toes should be checked routinely for swelling, coldness, and pallor of the nail beds
(where possible)
1. If any of these changes occur, the bandage should be loosened or changed, because
these signs may indicate poor venous return
D. The bandage should be loose enough to allow two fingers to slip under the bandage at all
times
E. Keep the bandage clean and dry when walking the animal
1. A small bag, an examination glove, or an empty fluid bag can be taped onto the
distal end of the limb and then removed after exercising

Paws
I. Reasons for bandaging
A. Declawing of cats
B. Dewclaw removal in dogs
C. Repair of lacerations
II. Precautions
A. The accessory pad should be included when bandaging the paw
B. A piece of cotton under the pad, as well as between the digits (canine only), helps to prevent
irritation or chafing
Tail (Figure 24-11)

FIGURE 24-11 Tail Bandage. (From Lane DR, Cooper B: Veterinary nursing, formerly Jones animal nursing, ed 5, Woburn, Mass, Butterworth-Heinemann, 1998.)

I. Reasons for bandaging

A. Partial tail amputation
B. Protection of wounds
C. Tumor removal
D. For long-haired cats or dogs with severe diarrhea, to keep the tail as clean as possible
II. Precautions
A. Sedation may be needed after amputation if bleeding persists from excessive tail wagging or
from hitting the remaining portion of tail on a hard surface
1. In cases of amputation, a hard tubular object fastened to the base of the tail
protecting the site is often helpful
a. Objects such as an empty cardboard roll or human finger splint can be
useful
b. Analgesics may be required for pain

Specialized Bandaging Techniques

I. Ehmer sling is a nonweight-bearing sling-type bandage used to support the hind limb after
reduction of hip luxation
II. Velpeau sling is used as a nonweight-bearing sling-type bandage (Figure 24-12 and 24-13) to
support the shoulder joint after surgery
FIGURE 24-12 The Velpeau sling. A, Wind the conforming bandage around the carpal. B, Flex the carpus. C, Apply a layer of
cohesive bandage over the top. (From Aspinall V: Clinical procedures in veterinary nursing, St Louis, Elsevier, 2003.)
FIGURE 24-13 The Ehmer sling. A, Wind the bandage around the metatarsal. B, Bring the bandage over the lateral thigh. C,
Apply a layer of conforming bandage. (From Aspinall V: Clinical procedures in veterinary nursing, St Louis, Elsevier, 2003.)

III. A carpal flexion sling is also a nonweight-bearing sling applied with the carpus flexed
A. It is used to allow the patient to have some movement of the shoulder and elbow
IV. Hobbles can be applied to hind limbs to prevent excessive abduction such as after the reduction of a
hip luxation

Casting Materials
I. Fiberglass cast (preferred method)
A. Lightweight and strong
B. Fast-setting cast
II. Plaster of Paris
A. Gauze roll impregnated with calcium sulfate dehydrate
III. Spoon splits made of plastic or aluminum can also be used to support fractured forelimbs
Aftercare of Bandages, Slings, and Casts
I. Close monitoring is essential
A. Note evidence of odor, edema, discharge, or skin irritation
B. Note warmth, color, and swelling of toes
II. Prevent the animal from chewing or licking the bandage
A. Discipline
B. Sedation
C. Elizabethan collar
D. Covering the bandage with a T-shirt or sock
E. Foul-tasting substances that can be applied to the dressing
III. When outdoors, protect the bandage from dirt and moisture by covering it with a plastic bag
IV. Exercise should be limited

CHAPTER 25

Equine Nursing and Surgery

PHYSICAL EXAMINATION AND NORMAL VALUES
I. Attitude
A. Bright, alert, responsive, quiet, dull, depressed, lethargic, ataxic, sternal, etc.
II. Temperature: 98.6 to 101.3 F (37 to 38.5 C)
III. Pulse: 24 to 48 beats per minute
A. Auscultate heart with stethoscope
1. Heart sounds
a. Four heart sounds may be heard, but often only two or three
2. Normal sequence of sounds in cardiac cycle is S4, S1, S2, S3
3. Loudest and most obvious sounds are S1 and S2
a. S1 is the first sound and is due to ventricular contraction
b. S2 is the second sound and is due to closure of semilunar valves
c. S3 is very faint and caused by blood rushing into the ventricles
d. Rarely audible S4 is caused by atrial contraction
B. Cardiac rhythm
1. A variety of rhythms are normal
2. Note heart rate, pulse quality, rhythm, intensity, extra sounds, absence of normal
sounds
3. Abnormal rhythms
a. Arrhythmia: absence of rhythm
b. Dysrhythmia: disturbance of rhythm
c. Tachycardia: dysrhythmia associated with heart rates greater than 50 beats
per minute
d. Bradycardia: dysrhythmia associated with heart rates lower than 20 beats
per minute
(1) Can occur due to hypocalcemia
 C. Atrioventricular (AV) block
1. May occur regularly or irregularly
2. First degree, second degree, or third degree (complete heart block)
3. During second-degree block, there is no S1 or S2 and no arterial pulse
4. Second-degree heart block may be present in horses that are not fit
a. Not always indicative of heart disease
b. There is a pause at regular intervals of the normal heart rhythm
c. Electrocardiogram (ECG) shows only a P wave between the regular P, Q, R,
S, and T waves at predictable intervals
d. The pause should disappear following exercise
e. Most common nonpathological arrhythmia
D. Atrial fibrillation
1. Most common pathological arrhythmia
2. There is no smooth signal from the sinoatrial (SA) node to the AV node and then to
the ventricles
3. Instead, multiple signals from the atria act as small SA nodes, some reaching the AV
node and ventricles
4. The atria and ventricles never relax or contract properly
E. Heart murmurs
1. Turbulent flow causes vibrations that are audible during normally quiet periods of
the cardiac cycle
F. Electrocardiographic monitor
1. A portable electrocardiographic monitor is used on the horse while it is standing
quietly
2. Used for a definitive diagnosis of arrhythmias/dysrhythmias
a. Evaluate the P, Q, R, S, and T waveforms
G. Facial artery
1. Located on medial aspect of mandible
2. Palpate artery to assess blood pressure during anesthesia
3. Use to determine if manual palpation of pulse matches the ECG
H. Coccygeal artery
1. Located in groove on dorsal aspect of tail
2. Use for blood pressure with a Doppler pressure monitor
IV. Respiration: 12 to 24 breaths per minute
A. Observe by watching horse's flanks and nostrils
B. Use stethoscope to listen to abnormal respiratory sounds
1. Place on trachea and on left and right lung fields
C. Horse must be relaxed in a quiet environment for assessment
D. Rhythm is important
1. Normal horsethe inspiration and expiration are followed by a pause
2. Abnormal or excited horseinspiration will be slightly longer than expiration
E. Signs of respiratory problems
1. Coughing or other abnormal respiratory sounds during rest or exercise
2. Nasal discharge
3. Epistaxis is the presence of blood in upper airway or nose as a result of:
a. Guttural pouch infections
b. Exercise-induced pulmonary hemorrhage
F. Hyperpnea is increased rate and depth of respiration
G. Dyspnea is labored breathing causing distress
 H. Pharynx and trachea examined with endoscope
V. Mucous membrane
A. Moist pink indicates healthy normal circulation
B. Very pale pink means the capillaries are constricted and indicates fever, blood loss, or anemia
C. Bright red means the capillaries are enlarged; indicates toxicity or mild shock
1. Described as injected when blood vessels are visible on the gums
D. Pale blue, gray, or whitish indicates anemia due to severe shock or illness
E. Yellow with a tinge of brown indicates jaundice and liver problems
F. Bright yellow shows high levels of beta-carotene in diet
G. Red or purple line along the teeth is a toxic line
VI. Capillary refill time (CRT)
A. Indicator of blood circulation
B. Checking CRT
1. Lift upper lip and apply pressure to the gums with a finger until the gum color fades
2. Release the pressure and count the seconds for color to return
a. 1 to 2 seconds is normal
C. Assess CRT in conjunction with mucous membrane color to assess health
VII. Gastrointestinal motility (borborygmus)
A. Bubbling, gurgling, rumbling (not unlike the sound of distant thunder)
B. Cecum is heard on the right side at the paralumbar fossa
1. No cecum sounds is cause for concern
C. Recording of gut sounds in four quadrants
1. Upper left and right at the paralumbar fossa
2. Lower left and right on the abdomen
3. Record sounds as absent or present
a. 0 is absence of sound
b. + (one plus) is hypomotile, few moving sounds
c. ++ (two plus) is normal, sounds do not overlap
d. +++ (three plus) is hypermotile with fast overlapping sounds
VIII. Digital pulses
A. Palpate each leg for arterial blood flow to the hoof
1. Palpate the artery where the vein, artery, and nerve are bundled together
2. Four common areas to palpate for a digital pulse
a. Above, below, and over the collateral sesamoidean ligament
b. Midway down pastern
B. Pulse strength varies from horse to horse
C. Compare pulse strength of all four feet to assess a localized or systemic problem
1. None to faint digital pulses are normal
2. Bounding digital pulses indicate inflammation
a. Assess corresponding hoof temperature
b. Bounding pulses in one leg may indicate localized hoof abscess
c. Bounding pulses in two or more legs may indicate laminitis
3. Laminitis may be due to systemic toxic changes
IX. Fecal output
A. Color varies with diet
B. Should be well-formed, moist balls that break easily when they hit the ground
C. Descriptors include hard, dry, soft, cow patty, diarrhea, and watery diarrhea
D. Frequency: approximately 8 to 10 times daily
X. Urine
 A. Colorless to yellow
B. Can be thick or turbid from high content of mucus and calcium carbonate crystals

DENTAL FORMULA AND CARE

Dental Formula
I. Foal has 24 temporary teeth
II. Adult has 40 to 42 permanent teeth
A. For a stallion, the dental formula is 2 (I 3/3, C 1/1, P 3/3, M 3/3)
B. Mares usually do not have canine teeth
C. Equine canine teeth are also called tushes

Dental Care
I. Wolf teeth or first premolars (P1) are located in the upper jaw
A. If wolf teeth do not fall out on their own, the veterinarian will have to extract them because
they can interfere with the bit
II. Anatomically, the horses upper jaw is wider than the lower jaw
A. When a horse eats, it grinds food in a side-to-side motion
B. This creates sharp edges on the buccal surface of the upper teeth and on the lingual surface
of the lower teeth
C. Rasping down these sharp edges is called floating the teeth
D. A veterinarian should check the horses teeth at least annually to determine whether
teeth need floating
E. Signs that an animals teeth need floating include:
1. Halitosis
2. Lacerations of oral cavity
3. Difficulty eating (tend to drop feed)
4. Head tilt and head tossing (especially when a bit is placed in their mouth)
5. Undigested food in feces

ROUTES OF MEDICATION ADMINISTRATION

I. Oral route
A. Powders, pastes (e.g., phenylbutazone, anthelmintics), boluses, pills, liquids
B. All of the above may be added to food (some after being dissolved in water) or dosed using a
syringe
II. Nasogastric (NG) tube
A. Placement
1. Tube is placed in the medial ventral meatus of the nasal cavity and passed into the
esophagus, usually by a veterinarian because of the risk of accidentally placing the
tube in trachea
2. Horse should swallow for the tube to enter the esophagus
3. Draw back on the tube with dosing syringe or mouth, checking for negative pressure
as the esophagus will collapse around the end of the tube
4. Blow small amounts of air into the NG tube as it is advanced to expand the
esophagus
B. Confirm tube placement
1. Observe the NG tube passing along the left jugular groove as it advances down the
esophagus
 2. Palpate the jugular groove to feel the end of the tube as it advances
3. Once NG tube is thought to be in the stomach, palpate the jugular groove near the
thoracic inlet for both the smooth NG tube and the cartilage rings of the trachea
4. Listen at the open end of the NG tube for stomach gurgling and sniff to smell for
stomach contents
5. Blow air into the NG tube while second person uses a stethoscope on the stomach to
hear gurgling noises
6. Place small amount of water in the tube and attempt to get reflux back, checking for
stomach contents, prior to administering any medications
C. Complications encountered when placing NG tube
1. Dorsal pharyngeal recess
2. Ethmoid turbinates in the medial dorsal meatus of the nasal cavity
3. Horse does not swallow
4. Collapsed arytenoid cartilages
5. Dorsal displacement of the soft palate
D. Indicators of NG tube in trachea
1. Positive pressure when drawing air back or blowing into tube to advance
2. Coughing
3. Air expulsion through tube on expiration
E. Common route for administering water, dewormer, mineral oil, and antigas medicine as well
as refluxing the stomach contents when assessing colic
III. Intravenous injection
A. Always swab injection site with alcohol before injecting
B. Common sites
1. Jugular vein is most common
2. Thoracic, cephalic, or saphenous veins used for small volumes if the jugular vein not
accessible
C. Before injecting medications, ensure needle placement in vein by getting blood flow back
1. See blood in needle hub prior to attaching syringe
2. With syringe attached, aspirate blood back
D. Normal needle gauges range from 14 gauge (catheters) to 16 to 21 gauge (jugulars) to 25 or
27 gauge (some local anesthetic agents)
E. Important to know properties of drugs before administering
1. Administer drugs, such as calcium, slowly so that heart rate is not adversely affected
F. Incorrect route of administration could damage the vein or cause anaphylactic reaction
G. Perivascular administration of some drugs can irreparably damage tissue and result in a
thrombosis of the jugular
1. Phenylbutazone (bute) is the most common drug administered to horses and
causes the most damage perivascularly
H. Only a few drugs are administered intravenously (IV)
1. Generally for rapid onset or administration of large volumes of fluids
2. Administer drugs as a bolus for effect (e.g., glycopyrrolate during anesthesia to
regulate heart rate)
IV. Intramuscular administration
A. The base of the neck
1. Form a visual triangle using three anatomical structures
a. The nuchal ligament along the crest (top) of the neck
b. The cervical vertebrae at the bottom of the neck
c. Cranial (in front) of the shoulder blade
 2. Injection site location
a. Place the heel of a hand at the base of the neck in front (cranially) of the
shoulder blade
b. Fingers should be pointing toward the horse's poll (top of head)
c. The area covered underneath the palm of the hand is the injection site
3. Keeping near the base of the neck helps to prevent muscle soreness
4. General rule is no more then 10 to 12 mL per injection site
5. Large doses of medication (15 to 20 mL) should be divided into two injection sites
B. Semitendinosus muscle
1. Located below the tuber ischii (the point of the horse's buttocks)
2. Injection site location
a. Go 1 to 2 inches below the tuber ischii
b. Injection can be given anywhere along the semitendinosus muscle
c. Avoid giving the injection in the space (looks like a crevice) between the
semitendinosus and the semimembranosus
3. To avoid getting kicked, stand close to the horse, reach across the hind end, and give
the injection on the opposite side
a. Horse will often kick out to side of where pain/irritation is coming from
C. Gluteal muscle
1. Given in the medial gluteal muscle (top of rump)
2. Not a recommended intramuscular injection site due to poor drainage, which can
lead to abscess formations
D. Pectoral musclepectoralis descendens (chest)
1. Use small volumes (1 to 10 mL)
2. Not commonly used as this site can cause problems with soreness
3. Safety can be an issue, as person is in the vulnerable position of having to lean
forward in front of horse, and can be bitten or struck with front feet
E. To ensure that the needle is not in a blood vessel, draw back on syringe plunger to check that
no blood is pulled into the syringe before injecting
F. Avoid injecting close to joints, blood vessels, or large fat deposits
G. IM route used to prolong drug action
H. Only safe route of administration for certain drugs
I. Procaine penicillin will cause an adverse reaction if administered into the bloodstream
V. Subcutaneous administration
A. Swab skin with alcohol as for intramuscular injection
B. Administer drug by pinching a loose fold of skin and placing needle tip into tented space
C. Normally injected into neck
D. Will normally leave skin bleb because of the close attachment of skin to underlying muscle
E. Always draw back on plunger to ensure that no blood is in syringe before injecting
VI. Intranasal route
A. Catheter is placed in the medial ventral meatus of nasal cavity
1. Administer medication directly onto the mucosa
2. Vaccination against strangles (Streptococcus equi) or against the influenza virus
3. Nasopharyngeal washes to collect a fluid sample to test for Streptoccocus equi
(strangles)
B. The advantage to this route is direct application of the drug to the primary area of concern
VII. Inhalation route
A. Nebulizers and AeroMasks used to deliver microdroplets of a drug
1. Mask is fitted over muzzle
 2. Medication administered into the mask via a special port
B. Aerosol inhalants
VIII. Topical route
A. Substances applied to skin, eyes, mucous membranes, and hooves
B. Eye creams and ointments must be placed onto the eye or into conjunctival sacs
C. Multiple applications of liquids may require a Mila eye lavage system (Mila International,
Erlanger, KY) placed into the upper eyelid and braided through the mane

Catheter Placement
I. Factors that determine site of catheter placement
A. Vein patency (filling of vein) irregularities, overuse, or thrombosis (vein completely
occluded)
B. Surgical recumbency (commonly on the nonrecumbent side)
C. Surgical procedure
D. Veterinarian or anesthetist preference
II. Supplies necessary for catheter placement
A. Clippers or razor; prep solutions; sterile gloves; extension line with three-way stopcock
B. Sterile 0.9% saline for catheter flush in a 12-mL syringe (minimum volume)
C. Catheter (Angiocath, short- or long-term Mila catheter)
D. A 3-mL syringe and 25-gauge 14-inch needle with lidocaine 2% without
epinephrine (placement of lidocaine skin bleb optional)
E. Suture ties or glue, tape, and/or elastic-type bandage (Expandover)
III. Clip or razor hair over jugular groove in a 1-inch to 2-inch square, approximately one third down
neck from point of the jaw
IV. Skin prep inside the clipped area using three separate prep solutions as per small animals
V. Wear sterile gloves to place the catheter (open glove technique)
VI. Catheter types include:
A. Angiocath
1. Short-term placement
2. Catheter-over-stylet style
B. Long-term Mila and Arrow catheters with butterfly extensions
1. Placement of 3 to 4 weeks' duration (according to manufacturers)
2. Catheter-over-guidewire style
C. Butterfly catheter
1. Needle size ranges from 19 gauge 34 inch to 25 gauge 34 inch
2. Used in horses for regional perfusions of antibiotics
D. Insyte catheter with wings
1. Placed for arterial blood gas sample collection during anesthesia
VII. Angiocath or short-term Mila catheter placement
A. Hold catheter with the bevel facing away from the horse and at a 45 angle
B. Occlude the vein below the prepped area. This hand is no longer sterile
C. Keep the catheter parallel to the jugular groove and insert the catheter into the vein (through
the lidocaine bleb if used)
D. Confirm catheter is in the vein. Remove finger from top of stylet and watch for saline to be
pushed up out of the hub
E. Decrease the catheter angle, staying parallel to the jugular groove, and advance further into
the vein. Confirm catheter is still in the vein
F. Hold stylet with nonsterile hand; with sterile hand advance the catheter over the stylet and
into the vein until the catheter hub is against the skin
 G. Suture tie or glue the catheter hub, wings of the Mila, and the extension set to the skin
keeping parallel to the jugular groove
H. Flush the catheter and extension set with 0.9% saline
VIII. Long-term Mila catheter placement
A. Common for use in lateral thoracic vein; jugular vein of neonatal foals; prolonged
administration of medications; in cases in which endotoxemia is the expected outcome, and in
cases with diarrhea
B. Person placing catheter must keep both hands sterile
C. Will need person to restrain animal (two or more for a foal)
D. May need chemical restraint
E. Catheter comes in a special kit
F. Prep is the same for Angiocath catheter placement
G. A needle or catheter is placed in the jugular vein as a guide for the wire to be advanced
through
H. Once the wire is in the vein, the needle or catheter guide is removed from the vein and over
the wire to be discarded
I. The catheter is passed over the wire and into the vein until the hub is against the skin
J. Attach the extension line with three-way stopcock
K. Suture tie the hub, wings, and extension line of the catheter, keeping parallel to the jugular
groove
L. The extension line with three-way stopcock is sutured to the neck, then either wrapped using
an elastic neck bandage (i.e., Expandover) or secured by a braid in the mane
IX. Maintaining catheter patency
A. Use 0.9% sodium chloride for catheter flushes
B. Administer saline flushes prior to and in between multiple medications, and after the last
medication
C. Ensure enough saline flush is used to clear the medication from the extension line and the
catheter
D. Administer saline flush a minimum of every 6 hours
E. Heparin (1:1000 IU) 1 mL per 100 mL of saline may be used to keep the vein patent

VACCINATIONS (Table 25-1)

TABLE 25-1
Equine Vaccinations

Foal Healthy Adult Horse Pregnant Broodmares

TETANUS TOXOID (CORE VACCINE)

FORMALIN-INACTIVATED ADJUVANTED WHOLE VIRUS

From vaccinated mares: 3-dose series at Vaccinated previously with 2-dose 4-6 wk prepartum annually to
4-6 mo of age, 4-6 wk later, and 10- regimen: Annual booster enhance the concentration of
12 mo of age Nonvaccinated or with status antitetanus antibodies in
Foal Healthy Adult Horse Pregnant Broodmares

From nonvaccinated mares: unknown: 2-dose series 3-6 wk mares colostrum

apart, then annual booster

3-dose series 4 wk apart starting at 3-4

mo of age
Antibody titers usually occur 2 wk after
second initial dose

May be given as an individual vaccine. Often combined with other vaccines to be given as an annual booster.
Administer for wounds if booster given more than 6 mo earlier. Administer before surgery performed.

TETANUS ANTITOXIN (CORE VACCINE)

From nonvaccinated mares: Shortly after Nonvaccinated: Induces short-lived,

birth immediate passive protection lasting
only 2-3 wk

Administer subcutaneously (SC), intravenously (IV), or intraperitoneally. Given to treat cases of tetanus. Minimum dose of
1500 IU within 24 hr of exposure to tetanus toxin. Massive initial doses are better than repeated smaller doses to
affect a cure. If wound present, increase dose relative to time of exposure to 30,000-100,000 IU. Produced by
harvesting antibodies from hyperimmunized donor horses.

RABIES (CORE VACCINE)

DERIVED FROM INACTIVATED TISSUE CULTURE

From vaccinated mares: 2-dose series 4- Vaccinated previously: Annual booster. No caution for vaccine use in
6 wk apart at no earlier than 6 mo Nonvaccinated or with status pregnant mares
of age unknown: Primary single dose, then Vaccinated previously:
From nonvaccinated mares: 2-dose annual booster
series at 3-4 mo of age then second
dose 4-6 wk later
4-6 weeks prepartum
From unknown vaccine status Before breeding
mares: Assume mare is antibody
positive and vaccinate as for foals Nonvaccinated or with
from vaccinated mares OR test status unknown:
blood serum for rabies antibodies 4-6 wk prepartum
from foal at 24 hr of age or from
the mare during periparturient
Foal Healthy Adult Horse Pregnant Broodmares

period

1. If serum is antibody negative, vaccinate

as for foals from nonvaccinated mares
2. If serum is antibody positive, vaccinate
as for foals from vaccinated mares

Inject a 2-mL dose intramuscularly (IM). Do not vaccinate within 21 days of slaughter. Exposure or suspected exposure to
a rabid animal is reportable. If exposure:

1. Immediate immunization may be allowed, along with monitoring for 6 months; OR

2. Euthanasia may be necessary.

EQUINE HERPESVIRUS (EHV): EHV-1, EHV-4 (RHINOPNEUMONITIS) (RISK-BASED VACCINE)

INACTIVATED (RESPIRATORY), INACTIVATED (RESPIRATORY AND ABORTION), MODIFIED LIVE VIRUS
(MLV) (EHV-1)

From vaccinated and nonvaccinated Vaccinated previously: 6-mo intervals: Vaccinated previously:
mares: younger than 5 yr of age, live on
Inactivated EHV-1/EHV-4 or MLV breeding farms, in contact with
EHV-1: 3-dose series at 4-6 mo of pregnant mares, frequent movement
Inactivated EHV-1 for abortion:
age, second dose 4-6 wk later, then farm to farm, stabled in high-risk at 5, 7, and 9 mo of gestation
third dose at 10-12 mo of age areas such as racetracks or horse Inactivated EHV-1/EHV-4: 4-
shows 6 wk prepartum
Nonvaccinated or with status
unknown: Inactivated EHV-1/EHV- Barren mares at breeding
4 or MLV EHV-1: 3-dose series 4- facility: Before start of
6 wk apart breeding
Stallions and teasers: Before the
start of breeding season
Areas of disease exposure:
Vaccinate regardless of vaccination
history

Vaccines are specifically labeled for respiratory disease or abortion. Vaccines have no label claim offering protective properties for the
neurological syndrome (equine herpesvirus myeloencephalopathy [EHM]) caused by EHV-1.
Horses naturally infected and recovered: Resume boosters 6 mo after disease occurrence

INFLUENZA (RISK-BASED VACCINE)

INACTIVATED VIRUS, MODIFIED LIVE VIRUS (MLV), CANARYPOX VECTOR
Foal Healthy Adult Horse Pregnant Broodmares

From vaccinated mares: Vaccinated previously: Vaccinated previously:

Inactivated virus or
canarypox vector: 4-
6 weeks prepartum
MLV intranasal: single dose or, if foal less Every 6 mo if at risk, otherwise annually
than 11 mo of age, give a 2-dose series To boost immunity if a potential outbreak,
Nonvaccinated or with
at 6-7 mo of age, then second dose at any of the three vaccine types may be status unknown:
11-12 mo of age given
Canarypox vector: 2-dose series 5 wk
apart at 6 mo of age
Nonvaccinated or with status
Inactivated virus: 3-dose series 4-6 wk Inactivated virus: 3-dose series,
apart at 6 mo of age for first and
unknown:
4-6 wk between first and
second dose, then third dose at 10-12 second dose, then third dose
mo of age MLV intranasal: single dose 4-6 wk prepartum
Inactivated virus: 2-dose series 4-6 wk Canarypox vector: 2-dose series,
apart, then every 6 mo 4-6 wk between first and
From nonvaccinated mares:
Inactivated virus: 3-dose series, 3-4 wk second dose and no later
between first and second dose, third than 4 wk prepartum
Full series as above dose 3-6 mo later, then every 6-12 mo
If vaccinated earlier than 6 mo of age due Canarypox vector: 2-dose series 4-6 wk
to a potential threat, the full series apart, then every 6 mo
should still start at 6 mo of age

Show horses: Do not vaccinate

within 7-10 days of a show
because of possible side effects

Vaccination rarely prevents infection; can reduce severity of disease and decrease its spread only. Side effects include fever, depression,
muscle stiffness, reaction at injection site. Blood serum tests will show antibody titer levels.
Maternal antibodies from the vaccinated mare may interfere with the vaccine if given to the foal prior to 6 mo. MLV intranasal provides
rapid protection within 7 days.

EQUINE ENCEPHALOMYELITIS: EASTERN (EEE), WESTERN (WEE), AND VENEZUELAN (VEE)

EEE/WEE: FORMALIN-INACTIVATED ADJUVANTED WHOLE VIRUS (CORE VACCINE)
VEE: KILLED PRODUCTS; MLV IF OUTBREAK ONLY

From EEE/WEE-vaccinated mares: Vaccinated previously for EEE/WEE: Vaccinated previously: 4-6 wk
prepartum
Nonvaccinated or with
status unknown: Immediate
3-dose series starting at 4-6 mo of age, 4- Annually prior to vector season
6 wk between first and second dose, Every 6 mo in high-risk areas
2-dose series 4 wk apart,
then prior to onset of vector season at then either 4-6 wk
10-12 mo of age
Nonvaccinated or with status prepartum or prior to onset
If earlier seasonal risk: 4-dose series at 2-3 of vector season, whichever
mo of age with first and second 4 wk
unknown for EEE/WEE: 2-dose
series 4-6 wk apart prior to next comes first
apart, third and fourth doses 4 wk
apart prior to onset of vector season at vector season, then annually
10-12 mo of age

From EEE/WEE-nonvaccinated
mares:
Foal Healthy Adult Horse Pregnant Broodmares

3-dose series at 3-4 mo, 5-6 mo, then 8-9

mo of age; series should be completed
prior to start of mosquito vector
season
If series started during vector season, then
third dose should be 3-4 wk after
second dose

Vaccinate against EEE and WEE in Canada and the United States. Vaccinate against VEE in states that border Mexico.
Vaccination for EEE/WEE may partially protect against VEE. Vaccination against VEE is controversial. In cool climates, administer the
vaccine in the spring when increased exposure to other horses and mosquitoes is more likely. In warm climates, biannual vaccination is
recommended.
Horses naturally infected and recovered: Likely have lifelong immunity, so only revaccinate if immune status of animal changes.

Streptococcus equi (STRANGLES)

KILLED (IM) AND MLV (INTRANASAL)

From vaccinated and nonvaccinated Vaccinated previously: Every 6-12 mo Vaccinated previously: Killed
mares: depending on risk of disease with M-protein: 4-6 wk
Nonvaccinated or with status prepartum
unknown: Nonvaccinated or with
status unknown: Killed
Killed with M-protein: if at high risk, 3-
dose series 4-6 wk apart at 4-6 mo of with M-protein: 2 or 3 doses
age at 2-4 wk apart, with final
Killed with M-protein: 2-dose or 3-dose
MLV: 2-dose series 3 wk apart at 6-9 mo
series 2-4 wk apart dose 4-6 wk prepartum
of age
MLV: 2-dose series 3 wk apart
MLV: safe to give as early as 6 wk of age,
Killed or MLV: every 6 mo or annually
then 2-4 wk before weaned in high-
after primary series completed
risk areas

Vaccine available as whole-cell bacteria and M-protein extract for IM injection. Vaccination usually limited to horses at
risk because of muscle soreness, incomplete protection, and unpredictable development of purpura hemorrhagica
(see Table 25-2). Increased risk of vaccine-associated adverse reactions when given to young foals. Not recommended
for infected or exposed horses.

Neorickettsia risticii (POTOMAC HORSE FEVER) (RISK-BASED VACCINE)

KILLED, ADJUVANTED

After 5 mo of age: 2-dose series 3-4 wk Vaccinated previously: Vaccinated previously: every 6-
apart, then at 12 mo of age 12 mo with 1 dose 4-6 wk
Before 5 mo of age: 2-dose series 3- prepartum
4 wk apart, then monthly until 6 Nonvaccinated or with
Every 6-12 mo
mo of age Endemic areas: every 3-4 mo due to short-
status unknown: 2-dose
Foal Healthy Adult Horse Pregnant Broodmares

lived/incomplete protection from

vaccine
series at 3- to 4-wk interval
Nonvaccinated or with status with second dose 4-6 wk
unknown: 2-dose series 3-4 wk prepartum
apart

Give vaccine prior to time of exposure to disease vector. No claim that vaccination prevents abortion. Low risk of clinical disease in young
foals.
Horses naturally infected and recovered: 12 months after recovery, give primary 2-dose series 3-4 wk apart or booster if vaccinated
previously.

WEST NILE VIRUS (CORE VACCINE)

INACTIVATED ADJUVANTED WHOLE VIRUS, RECOMBINANT CANARYPOX VACCINE, INACTIVATED
FLAVIVIRUS CHIMERA VACCINE

From vaccinated mares: Vaccinated previously: Vaccinated previously: 4-6 wk

prepartum
Nonvaccinated or with
status unknown:
3-dose series at 4-6 mo of age Annually in spring prior to insect vector
Inactivated whole: 4-6 wk between first season
and second dose, third dose prior to High-risk age group < 5 yr old or
onset of mosquito season at 10-12 mo > 15 yr old: more frequent to
Immediate primary 2-dose series
of age induce protective immunity during
Inactivated whole and
Recombinant canarypox vector and exposure periods
recombinant canarypox
inactivated flavivirus chimera: 4 wk
vector: 2-dose series 4-6 wk
between first and second dose, third
Nonvaccinated or with status apart
dose prior to onset of mosquito season
at 10-12 mo of age
unknown: Inactivated flavivirus chimera: 2-
dose series 3-4 wk apart
Inactivated whole and recombinant Annually after primary series
From nonvaccinated mares: completed
canarypox vector: 2-dose series 4-
6 wk apart
3-dose series at 3-4 mo of age Inactivated flavivirus chimera: 2-dose
Inactivated whole, recombinant canarypox series 3-4 wk apart
vector, and inactivated flavivirus Annually after primary series completed
chimera: 30 days between first and
second dose and 60 days between
second and third dose
If series initiated during mosquito season,
then 3-4 wk between second and
third dose
Foals vaccinating at a few days of age has
shown no adverse effects

Horses may develop immunoglobulin G and/or immunoglobulin M antibodies to the West Nile virus that would affect their ability to be
exported.
All three vaccines carry 1 year duration of immunity.
Horses naturally infected and recovered: Possible lifelong immunity. Revaccinate if immune status changes.

BOTULISM TOXOID (RISK-BASED VACCINE)

Foal Healthy Adult Horse Pregnant Broodmares

KILLED

From vaccinated mares in endemic Vaccinated previously: Vaccinated previously: Annual

areas: dose 4-6 wk prepartum
Nonvaccinated or with
status unknown:
3-dose series at 4-wk intervals
3-dose series at 4-wk intervals starting at 2 Annually after primary series completed
to 3 mo of age
Can be administered as early as 2 wk of
3-dose series 4 wk apart with
age
last dose 4-6 wk
prepartum.
From nonvaccinated mares (born or Ideally at 8, 9, and 10 mo of
moving to an endemic area): gestation

3-dose series at 4-wk intervals starting at 1

to 3 mo of age
High-risk foals as early as 2 wk of age

Vaccine against Cl. botulinum type B licensed in the Unites States for use in horses. Primary use of vaccine is prevention of shaker foal
syndrome through antibodies transferred in the vaccinated mares colostrum. Foals of unvaccinated mares in endemic areas may
benefit from a plasma transfusion collected from a vaccinated mare or from Cl. botulinum type B antitoxin.
No licensed vaccine against Cl. botulinum type C or other subtypes of the toxin. Cross-protection between type B and C does not happen.
Horses naturally infected and recovered: Immunity highly variable; 3-dose series at 4-wk intervals starting after full recovery from the
disease.
I. Vaccination programs should be developed in consultation with a licensed veterinarian
II. Vaccination programs may be determined according to a core versus risk-based need
A. Core vaccines
1. Are effective and safe for use in all horses
2. Protect against diseases that are endemic to a region; have a public health
significance; are legally required; are highly infectious/virulent; pose a risk of severe
disease
B. Risk-based vaccines
1. Risk-based vaccines are used against diseases that vary from horse to horse, among
populations of horses in a region, or among geographical regions. Risk-based vaccines
other than those included in Table 25-1 are anthrax, equine viral arteritis, and
Rotavirus
III. Additional criteria when creating a vaccination program
A. Potential exposure to disease due to age, breed, use, and sex of the horse
B. Morbidity/mortality of disease
C. Zoonotic potential
D. Effectiveness of vaccine chosen
E. Adverse reactions
F. Cost of immunization versus potential cost of treatment, loss of use, possible quarantine to
control an outbreak if horse develops clinical disease
IV. Vaccination expectations for disease management
A. Vaccination without good infection control management practices will not prevent disease
B. Vaccination minimizes the disease risk but cannot prevent disease
C. Administer vaccines prior to likely exposure to disease vector
D. Horse-to-horse vaccine protection varies in degree and duration
E. Protection from disease is not immediate following vaccination
1. Primary series of multiple doses is needed to induce a protective and active
immunity
V. Vaccinations routinely aseptically given intramuscularly
VI. Intranasal vaccine available for strangles and influenza
VII. Vaccines types
A. Live vaccine (canarypox vector)
B. Modified live vaccine
C. Recombinant vaccines
1. Live attenuated vector, chimeric, DNA, canarypox
D. Dead/killed:
1. Inactivated/killed pathogen, protein
2. Recombinant subunit
3. Adjuvants, formalin-inactivated whole virus
VIII. Side effects of vaccinations
A. At 24 to 48 hours after injection
1. Symptoms can include generalized muscle pain, mild lethargy, mild appetite loss,
and mild fever
2. If symptoms persist longer, other causes should be examined
B. Localized at injection site
1. Irritation, swelling, or abscess at injection site
C. Anaphylactic reaction, although rare
1. Treat with epinephrine
IX. Important to read directions for each brand of vaccine and utilize veterinarian knowledge
 X. Protocols for the core vaccines and a few risk-based vaccines are described in Table 25-1. See Table 25-
2 for descriptions of diseases that are vaccinated against

TABLE 25-2
Equine Diseases

Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

NEUROMUSCULAR DISEASES

Off feed or
depress
Rabies Lyssavirus Saliva of Central nervous ed Management: Yes
(Rhabdo rabid system Extreme Reportabl
aggress
viridae anima Transmissi e disease
ion
family) ls on: Dysphagia Quarantine
(typic Lack of Wear
ally coordin protect
racco ation ive
Saliva Hyperexcit
on, clothin
enters ability g
fox, bite Hydrophob
skunk wounds ia
, open Recovery:
, and Colic
cuts, Convulsion
bat)
onto s Progressiv
mucous Paralysis e
membr Self- disease
anes, or inflicte Death
through d usually
contact wounds within
with 3-5
potentia days
lly Euthanasia
infected and
material postmo
Virus rtem
migrate for
s along definiti
nerves ve
to brain, diagno
attackin sis
g the
central
nervous
system

Incubation period 2-10 wk. Test: Postmortem

 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Central Muscle
nervous stiffness
Tetanus (lockjaw) Clostridium Spores of system (sawho Management: No
tetani anaer From rse Vaccinate
neuroto stance)
(gram- obic Treatment
xins Dysphagia
positive bacter produc leading
:
anaerob ia in ed by to
ic soil the decreas
bacteria bacteria ed food
and Administer
) high
water
Transmissi
intake doses
on: Increased of
jaw tetanus
Contaminat tone antitoxi
ed Third n
punctur eyelid (antitox
e prolaps in
wounds e binds
Crushing Sensitive to to any
wounds light circulat
Open and ion
lacerati sound tetanus
ons Muscle toxins)
Surgical fascicul Sedation or
incision ation muscle
s Muscle relaxan
Umbilici of spasm ts for
foals (tetany) tetany
Spores can Systemicall
remain y:
dorman Intravenou
t in s (IV)
muscles penicill
and in
start IV fluids,
growin especia
g if lly if
trauma horse
occurs has
dyspha
gia
May need
to
evaluat
e
bladde
r and
bowel
Wound
treatm
ent:
clean,
drain,
local
infiltrat
ion of
penicill
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

in
Keep in
dark,
quiet
stall
Plug ears
with
cotton
to
reduce
noise
stimuli

Recovery:
Often fatal

Incubation period approx. 8 days with a range of 3-21 days.

Cl. tetani bacteria present in feces and intestinal tract of horses and humans.
Tetanus can affect humans, so vaccination is recommended.

Ataxia
Facial
Equine protozoal Protozoa Opossum Central nervous paralysi Management: No
myeloenceph (Sarcocy feces system s Vector
Head tilt
alitis (EPM) stis lesion manageme
Depression
neurona) dependent: Blindness nt
Dysphagia Treatment
Circling :
Hind end
Brain stem weakne
Spinal cord ss and
Peripheral ataxia Antibiotics
nerves Gluteal, long
tongue, term
Transmissi and Antiinflam
mastica matory
on:
tory drugs
muscle Nonsteroid
Oocysts in wasting al
feces Incontinenc antiinfl
develop e ammat
into Recumbenc ory
infectiv y drugs
e
(NSAI
sporocy
Ds)
sts in
such as
the
phenyl
environ
butazo
ment
ne and
Infective
flunixi
sporocy
n
sts
meglu
contami
mine
nate
Corticoster
horses'
oids
feed,
Dimethyl
water,
sulfoxi
grass
de
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

From (DMSO
intestin )
al tract Vitamin E
into the and
bloodst folinic
ream acid
and Antiprotoz
across oal
the drugs:
blood- trimeth
brain oprim-
barrier sulfadi
azine
and
pyrime
thamin
e
Oral
coccidi
ocide:
ponazu
ril
(Marqu
is),
nitazox
anide
(Navig
ator)

Recovery:

Complete
recover
y not
always
possibl
e
Relapses
are
commo
n

Tests: cerebrospinal fluid (CSF) tap for diagnosis. CSF examined for antibodies to Sarcocystis neurona or protozoal DNA.
Incubation period from weeks to two years.

Lymphatics Fever,
to modera
Equine Alpha virus Mosquito lymph te to Management: Yes
encephalom 3 Natur nodes severe, VEE is
Brain for 24-
yelitis strains: al reportable
lesions 48 hr
(sleeping Reser develop Depression foreign
Vaccinate
sickness) voir: Inappetanc Vector animal
e
Eastern Transmissi manag
Increased ement
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

(EE on: heart

E) rate
Indirect Treatment
Western (HR) disease
(WE
transmissio Nervous
:
E) n from signs
Venezu EEE/ mosquito usually Antiinflam
elan W infected develop matory
(VE E later: drugs
after
E) E: Anxious, Fluid
bi
feeding on excited, therap
r reservoir restless y
d host Exaggerate Corticoster
s d oids
o respons Anticonvul
r e to sants
r touch Emphasis
o on
d suppor
Brain
e tive
n
lesions nursin
ts cause: g care
VEE:
h Head Recovery:
o pressin
rs g and
Survivors
e circling
exhibit
in stall
abnor
Drowsiness
mal
,
mentat
droopi
ion
ng ears
and/or
Seizures
spinal
Dysphagia
cord
Incoordinat
abnor
ion
malitie
Paralysis
s
Loss of
Death is
conscio
commo
usness
n 2-4
days
Death after
VEE: sympto
diarrhea ms
occur
VEE can be
lethal

EEE incubation period 3-7 days, VEE incubation period 2-4 days.
EEE most virulent, young horses more susceptible and highest mortality rate. WEE has lowest mortality.
Tests: minimum alveolar concentrationenzyme-linked immunosorbent assay (MAC-ELISA), paired serum neutralizing antibody titers,
CFS tap, polymerase chain reaction (PCR) on CSF sample but sensitivity limited, postmortem.
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Fever (may
be
West Nile Flavivirus Mosquito Swelling and absent) Management: No
meningomye Natur inflammati Inappetanc
e/anor
loencephaliti al on of the
exia
s Reser brain and Depression Vaccinate
voir: spinal cord Listlessness Revaccinat
Birds Sensitivity e if
to immun
touch e status
Cranial change
nerve s due
paralysi to
s long-
Neurologic term
al use of
signs: cortico
Front or steroid
hind s or
end pituitar
weakne y
ss adeno
Toe ma
draggin Vector
g manag
Limb ement
paralysi
s
Ataxia
Treatment
Head and :
neck
tremors Antiinflam
Aggression matory
Circling drugs
Seizures Short-
Coma acting
Death cortico
steroid
s
Fluid
therap
y
DMSO IV

Recovery:

Recovery is
possibl
e
Recovered
horses
may
have
lifelong
immun
ity

Incubation period 7-10 days.

 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Young, elderly, and ill most susceptible. Horses and humans considered end hosts.
Tests: MAC-ELISA, plaque reduction neutralization test (PRNT), CFS analysis, postmortem.

DNA Nervous
viru system:
Viral s equine Neurological: Management: No
rhinopneum Equ herpesv
ine irus
onitis
her myeloe
pes ncephal Fever Vaccinate
viru opathy Uncoordina mares
s (EHM) ted to
type Reproducti Incontinent prevent
1 ve Ataxic in abortio
(EH Respiratory hind n
V-1) tract limbs Vaccinate
(Type 4 Loss of tail foals,
[EH
Transmissi tone weanli
V- Hind limb ngs,
4]:
on:
paralysi yearlin
see s gs,
und Aerosolized leading young
er secretio to dog horses
Res ns from sitting up to
pira cough or 5 yr
tory Environme recumb of age
Dise nt ency for
ases Fomites EHM, a respira
) Aborted paralyti tory
fetuses, c disease
fetal neurolo Isolation
fluids gical for 28
and disease days
placent after
ae from diagno
abortio Reproduct
sis
ns ive:

Treatment
Epidemic
abortio :
n
Birth of Antibiotics
weak, Antiinflam
nonvia matory
ble drugs
foals Corticoster
oids
Respirator
y: Recovery:
See under Lifelong
Respirator latent
y Diseases infection
(EHV-4) can lead to
shedding
of virus
when
stressed
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Incubation period 24 hr to 4-6 days.

Abortion may follow fever and respiratory signs 2 wk to several mo after infection.
Respiratory disease occurs in foals in first wk or mo of life. Older horses do not show serious respiratory symptoms but are a source of
exposure.
Neurologic symptoms more commonly seen in mature horses (> 5 yr old).
Tests: virus isolation, PCR (real time), serology (viral neutralization titers).

Central Muscle
nervous weakne
Botulism Clostridium Spores in system ss and Management: No
botulinu soil, Toxins tremors
produc Muscle
m veget
ed in fascicul
(anaero ation, gastroin ation Vaccinate
bic decayi testinal Ataxia Vector
bacteria; ng (GI) Tongue manag
7 carcas tissues paralysi ement
s Feed good-
subtype ses
Dysphagia
s, A-G) (carri Transmissi quality
Droopy feed
on) on: eyelids from
and reliable
Ingestion of unable sources
spoiled to blink
feed or or close
carrion- Dilated
Treatment
contami pupils :
nated Recumbent
feed Depressed Administer
Wounds reflexes polyval
contami Urine ent (A-
nated retentio E)
with n antitoxi
spores Flaccid n in
from paralysi early
soil or s stages
vegetati Dyspnea Plasma
on Cyanosis produc
Progressive ts
paralysi contain
s of ing
respirat type B
ory antitoxi
muscles n
Death IV fluids:
Death with lactate
no d
clinical Ringer'
signs s
solutio
n (LRS)
IV
parente
ral
nutritio
n
Nasogastri
c (NG)
feeding
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

s
Activated
charco
al,
minera
l oil, or
sodium
sulfate
by NG
tube
Antibiotic
treatm
ent of
wound
s and
aspirati
on
pneum
onia
Eye
ointme
nts
Analgesics
Urinary
cathete
rizatio
n
Evaluate
fecal
output
and
texture
Deeply bed
stall

Recovery:

Poor
progno
sis but
recover
y
possibl
e if
treated
early
Sudden
death
with
no
clinical
signs

Incubation period 12-24 hr.

Decaying hay, grain, grasses, spoiled silage.
Subtypes B and C associated with equine outbreaks.
Toxins bind to nerves and block cell impulses. Antitoxin binds with circulating toxins in the bloodstream. Antitoxin must be subtype
specific.
Test: mouse toxin assay detects and types the toxin. Real-time PCR, ELISA, electrochemiluminescence (ECL), serology are not useful for
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

diagnosis.

Central Impaired
nervous sucking
Toxicoinfectious Clostridium Intestinal system Inability to Management: No
botulism botulinu infecti Toxins swallo As above
produc w
(shaker foal m on for
ed in GI Decreased
syndrome) (anaero tissues eyelid Botulism
bic and tail Treatment
bacteria Transmissi tone :
) Dilated
on: pupils
Stiff-legged
Ingestion of gait Administer
spoiled Progressive polyval
feed or muscul ent (A-
feed ar E)
contami weakne antitoxi
nated ss and n in
with fascicul early
carrion ations stages
Inhalation leading Ventilator
Wound to IV fluids
contami collaps (LRS)
nation e IV
Inability to parente
rise ral
Weak and nutritio
unable n
to stand NG
for long feeding
Intercostal s
muscle Antibiotic
paralysi treatm
s ent
(sla
b
side
Recovery:
appeara Death
nce) results
Progressive from
paralysi
respiratory
s of
respirat paralysis
ory and within 24-
cardiac 72 hr of
muscles the onset
Death 24-
of clinical
72 hr
after signs
the
onset of
clinical
signs

Incubation period 12-24 hr, up to 7-10 days.

Affects foals 2 wk to 8 mo of age.
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Violent
muscle
Hyperkalemic Quarter Inherited Affects sodium fascicul Management:
periodic horse as channels in ations Diet:
Muscle
paralysis genetic autos muscle
weakne
(HYPP) mutatio omal cells and ss
n domi the ability Uncontrolla
Feed
nant to regulate ble
several
trait potassium shaking
times a
Weakness
levels in day
in hind
the blood Feed low-
end
potassi
(dog-
um
sitting
food
posture
Grass or
)
oat hay
Ataxia
(no
Colic like
alfalfa)
episode
Plenty of
s
fresh
Sweating
water
Respiratory
distress
Prolapsed Minimize
third stress in
eyelid affected
Loose feces
horse
Abnormal
whinny Regular
Diaphragm exercise
paralysi and
s turnout in
Death in a
large
severe
attack paddock/
pasture
Treatment
:

Acetazola
mide
(2-4
mg/kg
orally,
every
8-12
hr)
Hydrochlo
rothiaz
ide
(0.5-1
mg/kg
orally,
every
12 hr)
Aim is to
reduce
clinical
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

sympto
ms
Response
varies
from
horse
to
horse

Recovery:
No cure

Occurs in 1 in 50 quarter horses. Origin of disease traced back to quarter horse stallion Impressive.
Test: DNA blood test to determine homozygous for mutation, heterozygous carrier, or normal.

RESPIRATORY DISEASES

Equine Fever
influenza Harsh, dry
A (flu) Orthomyxo Subtype AE-2 is cough Management: No
Subtype AE- virus most Mucopurul
1:H7N7 ent
common
Subtype AE- nasal
2: H3N8 Transmissi dischar Vaccinate
on: ge (sympt
Lethargy/d oms
epressi less
on severe
Aerosolized Increased and of
secretio lung shorter
ns from sounds duratio
cough Loss of n in
Fomites appetit vaccina
Survives for e ted
hours Constipatio horses)
in the n Quarantine
environ Muscle new
ment sorenes horses
s for 14
Distal limb days
edema
Cardiac
myopat
hy

Incubation period 1-3 days.

Young animals (1-5 yr old) most susceptible.
Highly contagious. Shedding can occur for up to 10 days.
Affects horses, donkeys, mules, zebras.
Tests: virus isolation, PCR, immunoassay, serology.

DNA
viru
Viral s Upper Respiratory: Management: No
rhinopneum Equ respiratory
ine
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

her
pes
onitis viru tract
s epithelium
type
and
4 Fever Vaccinate
(EH associated Inappetanc to
V-4) lymph e reduce
(Type 1 nodes Lethargy respira
[EH Transmissi Anorexia tory
V- Nasal infectio
on:
1]: dischar n
see ge (rhinop
und Cough neumo
er Increased nitis) in
Neu Aerosolized lung foals,
rolo nasal sounds weanli
gica secretio Swelling of ngs,
l ns lymph yearlin
Dise Fomites nodes gs, and
ases possibl young
) e perfor
mance
and
show
horses
Isolation
for 28
days
after
diagno
sis

Treatment
:

Antibiotics
to help
prevent
second
ary
infectio
ns of
bronch
itis or
pneum
onia of
the
lower
airway
Keep
warm
in well-
ventilat
ed stall
Plenty of
fresh
water
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Avoid
stress
Exercise
for
brief
periods
to keep
blood
and
lymph
circulat
ing

Recovery:

1-3 wk
Older
horses
may
develo
p some
immun
ity to
the
respira
tory
disease
Lifelong
latent
infectio
n can
lead to
sheddi
ng of
virus
when
stresse
d
Death can
occur
in
areas
of
overcro
wding

Incubation period 2-10 days.

Respiratory disease occurs in foals in first wk or mo of life. Older horses do not show serious respiratory symptoms but are a source of
exposure.
Tests: virus isolation, PCR (real time), serology (viral neutralization titers).

Bacteria Nasal Upper Fever, 24-

(Str d respirat 48 hr
Strangles epto is ory prior to Management: No
(distemper) cocc c tract other
us h Lymph clinical
equi a nodes signs
var. r Submandib Lymphade Vaccinate
equi) g ular nopath Isolate for
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Streptoc e Guttural y: 6 wk
occ Pus pouche Retrophary Disinfect
us s ngeal or burn
zoo Throat Submandib anythi
epid ular ng
emi contam
Transmissi
cus: Abscess inated
simi
on: es by
lar Mucopurul infecte
clini Direct horse ent d
cal to horse nasal animal
sign (infecte dischar
s d or ge
Treatment
but subclini Pharyngitis
is cal Dysphagia
:
not shedder Upper
cont s) airway Antipyretic
agio Fomites stridor s for
us fever
Penicillin
Purpura
antibio
hemorrhag tics:
ica: may be
contrai
Caused by ndicate
natural d after
or abscess
vaccine es have
exposur begun
e to formin
strep g
antigen IV fluids
s and
Acute feed
Noncontagi slurries
ous if
Clinical dyspha
signs in gic
2-4 w Hot pack
k abscess
Urticaria es to
with quicke
pitting n
edema matura
of tion
limbs, Lance
abdom abscess
en, and es to
head encour
Subcutaneo age
us draina
petechi ge
al Clean
hemorr burst
hage abscess
Sloughing es with
of dilute
affected povido
tissues ne-
 Management/
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recovery

iodine
solutio
Bastard
n
strangle: Keep
Lymph warm,
nodes in with
thorax fresh
water
and/or
availab
abdomen le

Recovery:

May be
intermi
ttent
sheddi
ng for
months
to
years
Develop an
immun
ity for
5 + yr
Test for
immun
ity
level
from
natural
infectio
n or
from
vaccina
tion

Incubation period 3-14 days.

Highly contagious.
Affects mainly young horses (weanlings and yearlings) and older horses (> 15 yr old).
Tests: bacterial culture, PCR, SeM-specific ELISA. Nasopharyngeal wash samples collected for testing. Three consecutive weekly negative
PCR and bacterial culture tests from nasopharyngeal washes are needed for horse to be considered free of infection.

Lungs:
pneum
Rhodococcus equi Coccobacillu Soil onia Respiratory: Management: Yes, if already
(previously s and immunoc
lung
Corynebacteri bacteria ompromis
abscess
um equi) (gram es ed
Pneumonia Environme
positive GI tract Lung ntal:
) abscess avoid
Transmissi es dirt
on: Cough paddoc
Lethargy ks or
Harsh lung overcro
Inhalation sounds wding
of dry, Wheezes foals
dusty and Isolate
 Management/
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recovery

soil crackles pneum

Ingestion of Increased onia
contami respirat foals
nated ory rate Monitor
soil (RR) foals
and daily
effort for
Nasal/ocul clinical
ar signs
dischar of
ge cough,
Fever fever,
Stiff not
gait/la nursin
me g
Joint Hyperimm
swellin une
g, mild plasma
to IV at 1-
severe 2 days
of age
Diarrhe and
a again
Hyperfibri at
nogene 3 wk
mia
Neutrophili
Treatment
c
leukocy
:
tosis
Uveitis Antibiotic
Death oral
therap
y:
Gastrointe
rifampi
stinal: n and
either
Diarrhea erythro
Abscesses mycin,
clarithr
omycin
, or
azithro
mycin
Anti-
inflam
matori
es:
ketopr
ofen or
flunixi
n
meglu
mine
Antiulcer
medica
tion
IV fluid
therap
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

y
Nasal
oxygen
if
severe
respira
tory
sympto
ms
Bronchodil
ator
medica
tions
Clean,
well-
ventilat
ed stall
Feed dust-
free
feed

Recovery:

70%-90%
surviva
l rate
with
approp
riate
treatm
ent
80%
fatality
withou
t
approp
riate
treatm
ent
Intestinal
disease
has
poor/g
rave
progno
sis

Affects foals 4-12 wk of age. Peaks at 6-12 wk.

Foals with fever still appear bright and alert, nursing normally.
Test: complete blood count and fibrinogen, fecal staining and bacterial culture, tracheal aspirate, ultrasound of chest, radiograph of lungs

GASTROINTESTINAL DISEASES
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Aqua Enterocoliti
ti s
Potomac horse Neorickettsia c Intracellula Highly variable: Management: No
fever (PHF) risticii in r
s bacteriu
(monocytic (formerl
e m
ehrlichiosis y ct Depression Vaccinate
or equine Ehrlichia s
Transmissi Anorexia Vaccine
ehrlichial risticii) Fresh Fever of benefit
w
on:
colitis) acute s
at onset questio
er Ingestion of Diarrhea nable
s tremato Mild colic due to
n des in Ileus presen
ai aquatic Decreased ce of 6
ls insects GI strains
Whole sounds of PHF
blood Abdominal Vaccinatin
transfus distenti g may
ion on only
from Edema of lessen
infected limbs, severit
donor ventral y of the
Transplacen body, disease
tal prepuc Isolation
e due to
Dehydratio diarrhe
n a
Toxemia Vector
Laminitis manag
second ement
ary to
toxemia Treatment
Abortion
:
late in
gestatio
n from Oxytetracy
fetal cline
infectio IV if
n severe
Doxycyclin
e orally
if mild
Fluid
therap
y with
balance
d
electrol
yte
solutio
n to
offset
diarrhe
a
NSAIDs
for
fever
DMSO IV
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
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recovery

Biosponge
or
activat
ed
charco
al to
bind
endoto
xins
Polymyxin
B or
plasma
pentoxi
fylline
Acepromaz
ine
intram
uscular
ly

Recovery:
Potentially
fatal

Incubation period 1-3 wk.

Foals are at low risk.
Affects any age, breed, or sex. No natural transmission horse to horse.
Can occur concurrent with Salmonella infection.
Tests: ELISA, immunofluorescent antibody (IFA) titers, PCR (on blood and feces).

Salmone
lla
Salmonellosis spp. Bacterial Gastrointestinal Management: Yes, especially
bact Transmissi if already
eria
on: immunoc
> 2500
sero ompromis
Diarrhea, Isolation
type soft to Shedding ed
s watery time individual
Ingestion of
contami
projecti several s or
le days to children
nated
Lethargic/ 30 +
material
depress days
or feces
ed Chronic
Inhalation
Colic sheddi
Fomites
Fever ng can
Causes of
Tachycardia occur
sheddin
Anorexia but is
g:
Neutropeni uncom
Stressful
a mon
situatio
Leukocytop Environme
ns, such
enia ntal
as
Hypokalem chemic
trailer
ia al
transpo
Hypoprotei disinfe
rt
nemia ction
Sudden
Hypocalce
changes
mia
in Treatment
High
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

feeding packed :
Antibiotic cell
use volume
Fluid
Sickness from
therap
Surgery dehydr
y with
Immunosu ation
a
ppressi Localized
balance
on infectio
d
Nosocomial n of
electrol
origin joint or
yte
bone
solutio
Endotoxem
n
ia
Potassium
Laminitis
and/or
second
calciu
ary to
m
endotox
added
emia
to
fluids
Plasma
transfu
sion
may be
require
d if
hypopr
oteine
mia
Feed free
choice
hay but
no
grain
Antiinflam
matory
drugs:
flunixi
n
megla
mine

Sodium
bicarbo
nate
fluids
to
correct
metabo
lic
acidosi
s

Recovery:
5
consecutiv
e negative
fecal
cultures
 Management/
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Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

needed
after
clinical
signs
resolve

Incubation period 12 + hr. Varies due to amount ingested and virulence of organism.
In 60% of cases the serotype is S. typhimurium.
Tests: Salmonella-specific fecal culture with serotyping and antibiotic testing of isolated organism.

Clostridi Severe colic

um Increased
Anterior enteritis spp. Small intestine RR Treatment:
(duodenitis imp Increased
licat HR
proximal
ed Fever
jejunitis) Idiopat possibl Frequent
hic e NG
Gastric intubat
reflux ion to
when empty
NG stomac
tube h of
passed fluid
Severe buildu
inflam p
mation Fluid
of the therap
small y IV
intestin Antiinflam
e can matory
lead to drugs:
ileus flunixi
Hypomotil n
e or megla
absent mine
GI (NSAI
sounds D)
Antibiotics
potenti
ally
Monitor
for
toxemi
a:
temper
ature,
mucou
s
membr
anes,
capillar
y refill
time,
digital
pulses

Symptoms can mimic bowel obstruction. Colic signs decrease after NG tube passed, unlike with obstructed bowel.
Diagnosis made by veterinarian performing a rectal examination.
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Dull
Lethargy
Lawsonia; equine Lawsonia Feces of GI tract: small Fever Management: No
proliferative intracell dome intestine Weight loss
Diarrhea
enteropathy ularis stic or hypertroph
Colic
(EPE) (gram- wild y Anorexia Vaccine not
negative anima (thickening Ventral labeled
bacteria l ) as well as edema for use;
) the large Blood experi
analysis mentall
intestine
: y has
Transmissi Leukocytos shown
on: is good
Ingestion Hypoprotei results
of nemia Isolate
Hypoalbu weanli
contaminat
minemi ngs
ed feces a with
Hyponatre diarrhe
mia a
Hypokalem Feed high-
ia protein
Hypocalce diet
mia
Neutropeni
a
Treatment
Hyperfibri :
nogine
mia IV fluids:
Metabolic LRS
acidosis supple
mented
with
electrol
ytes
Sodium
bicarbo
nate IV
to
correct
metabo
lic
acidosi
s
Plasma
transfu
sion
Antibiotics
Antiinflam
matory
drugs
Antiulcer
drugs
Parenteral
nutritio
n if off
feed
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Recovery:

Fatal if left
untreat
ed
Recovery
takes
several
weeks
Prognosis
good if
accurat
ely
diagno
sed
and
given
suppor
tive
care
and
antimic
robial
medica
tions

Primarily affects weanlings 3-8 mo of age.

Tests: PCR of feces, serology for antibodies to bacteria.
Diagnosis: ultrasound shows thickened loops of small intestine.

BLOOD DISORDERS

Equine Bloo Blood

infe d leukocy
Equine infectious ctio Seme tes Acute: Management: No reportable
anemia us n Plasma disease
ane Tissu during
(EIA)
mia e febrile
(swamp viru episode Fever Lifelong
fever) s s Depression isolatio
Lentivir Anemia n
us
Transmissi Weakness Euthanasia
on: Edema of Vector
lower control
legs
Horseflies and
and Recovery:
abdom
deerflie en
s Weak pulse No cure
Blood Irregular Infected
transfus HR horses
ions Blood- carry
In utero stained the
transfer feces disease
Fomites Death for life
 Management/
Virus/ Area affected/
Disease Vector Clinical signs treatment/ Zoonotic
bacteria transmission
recovery

Dirty
needles
Subacute:
Surgical
instrum
ents Recurrent
Teeth floats fever
Weight loss
Enlarged
spleen
(on
rectal
exam)
Anemia
Ventral
edema

Chronic:

Recurring
acute
sympto
ms
Weight loss
Ventral
edema

Asymptom
atic
Will test
positive

Incubation period 1 wk to 45 + days.

Symptomatic horses more likely to transmit the disease.
Tests: Coggins or agar gel immunodiffusion (AGID), ELISA, reverse transcriptasePCR (RT-PCR).
Negative Coggins is required for horses traveling between countries, admission to racetracks, horse shows, sales.
GASTROINTESTINAL AILMENTS
The management of all ailments and diseases is at the discretion of a veterinarian.

Common Clinical Signs

I. Restlessness, anxiety, or agitation, pawing, pacing/stall walking, flank watching and possible biting at
flank, kicking at abdomen, sweating, getting up and down in stall, rolling, grinding teeth, distended
abdomen, increased heart rate and respiration rate
II. Mucous membranes can be pale, bright or brick red, or cyanotic
III. Toxic line on gums just above teeth may be present
IV. Increased CRT (> 1 to 2 seconds)
V. Gastrointestinal motility may be hypermotile, hypomotile, or absent
VI. Digital pulses bounding with increased heat in hoof wall
VII. Fecal output can be absent, small number of hard, dry balls, or cow patty form, to diarrhea
VIII. Sawhorse stance (standing stretched out) or dog sitting
IX. Decreased appetite
X. Reflux, via NG tube, is often present (can be absent or up to 15 L [3.5 gal] in an average-size horse)

Common Equine Gastrointestinal Ailments

I. Colic
A. Refers to abdominal pain
1. Most commonly seen ailment
B. Gastrointestinal causes include excessive gas, spasmodic colic, ileus, parasitic infestation,
volvulus, intussusception, impaction, obstruction, displacement, inguinal hernia, ulcer
C. Signs vary with the severity of the colic and disposition of the horse
D. Not all of these clinical signs will be seen in each case
E. Management of colic consists of one or more of the following
1. Fluid therapy, antiinflammatory drugs, mineral oil, antiflatulence medication,
monitoring, antiulcer medications
F. Monitoring includes:
1. Vital signs, gastrointestinal motility, fecal output, hydration status (packed cell
volume [PCV] and total protein [TP]), obtaining nasogastric reflux (recording of how
much), walking, gradual introduction of food to the animal
G. In cases where surgery has been performed or toxemia occurred, digital pulses are also
extremely important to monitor for laminitis
II. Colitis
A. Acute inflammatory process of the large colon and cecum
B. In most cases of acute colitis, a cause is unknown
1. Possibilities include dietary change, carbohydrate overload (eating too much grain),
Salmonella spp., Clostridium perfringens, Clostridium difficile, Potomac horse fever,
antibiotic therapy, overuse of nonsteroidal antiinflammatory drugs
C. Clinically, horses present with inappetance, dull/depressed, abdominal pain, change in
gastric motility (can be either hypermotile or hypomotile), increased heart and respiration
rates, change in mucous membranes (can be brick/dark red, muddy, or cyanotic)
D. CRT is increased (3 to 4 seconds), diarrhea (varying from cow patty to profuse watery
diarrhea), dehydration, hypoproteinemia, electrolyte imbalances (hyponatremia,
hypokalemia, hypocalcemia), metabolic acidosis (severe cases)
 1. In severe cases, shock due to endotoxemia
E. Management of colitis
1. Fluid therapy with a balanced electrolyte solution (e.g., lactated Ringers solution
[LRS])
2. If needed, addition of potassium chloride and calcium to LRS
3. If needed, sodium bicarbonate to correct metabolic acidosis
4. Plasma transfusion if TP low (< 4.0 g/dL)
5. Antiinflammatory drugs
F. Monitoring
1. Vital signs, PCV and TP, blood gas and electrolytes, digital pulses and heat (signs of
laminitis) in hooves
G. Usually free-choice grass hay is offered, but grain is withheld
H. Horses with diarrhea are kept isolated because of the possibility of salmonella infection
1. When a horse is receiving intravenous fluids, it is vital that the indwelling catheter
be monitored for heat, swelling, or pain
a. This is very important, because horses with colitis are prone to developing
thrombosis of the jugular vein
III. Intestinal clostridial infections
A. An acute inflammatory process of the bowel
B. Clostridium difficile is the most common form
1. Clinically, horses present with signs similar to those of colitis, often no initial
diarrhea, severe abdominal pain, increased gut motility (hypermotility), diarrhea
within a matter of hours
C. Management is the same as for colitis and salmonellosis
D. The antibiotic metronidazole, given orally, may be effective in some cases
IV. Further rule outs (see Table 25-2)

NEUROMUSCULAR DISORDERS
Common Clinical Signs
I. Ataxia, depression, circling, head tilt, head pressing, nystagmus, facial paralysis, drooling,
incoordination, limb knuckling and toe dragging, muscle wasting, prolapsed third eyelid, seizures,
altered behavior

Common Equine Neuromuscular Disorders

See Table 25-2.

RESPIRATORY DISEASES
Common Clinical Signs
I. Coughing, clear runny nasal discharge, secondary bacterial infection causes purulent discharge,
depression, anorexia, dyspnea, tachypnea, pyrexia

Common Equine Respiratory Diseases

See Table 25-2.

BLOOD DISORDER
See Table 25-2.
FOOT AILMENTS
I. Laminitis (founder)
A. Inflammation of the sensitive laminae of the feet
1. Most commonly occurs in the front feet, but can occur in the hind feet
B. Caused by grain overload, ingestion of large amounts of cold water (water founder),
endotoxemia, concussion (road founder), hormonal influences, previous viral respiratory
diseases, previous administration of drugs, overeating lush pastures particularly in the spring
C. Clinically, horses will be reluctant to move, be anxious (in extreme cases), toe point, rock
back on the heel to relieve the pressure on the toe, be pyrexic, be depressed, be off feed, have
increased heat in the hoof wall and bounding digital pulses as a result of increased blood
flow, be sensitive to hoof testers
D. In extreme cases, the coffin bone rotates and can come through the sole of the foot
E. Radiographs are used to determine degree of rotation
F. Management
1. Antiinflammatory drugs
2. Isoxsuprine hydrochloride (vasodilator)
3. Nitroglycerin applied to the medial and lateral digital arteries (vasodilator)
4. Acepromazine
5. Fluids (LRS)
6. Grass hay free choice, no grain
7. Corrective hoof trimming
8. Cold hosing and icing feet may also be done; however, this treatment is controversial
9. Foot pads
II. Navicular syndrome
A. Degeneration of the navicular bone
B. Exact cause unknown
C. Clinically, horses may stumble, have a shortened stride, be intermittently lame
D. When pressure is applied over the sole of the foot with hoof testers, a horse with navicular
disease will react by pulling the foot away in response to pain
1. To further diagnose navicular syndrome, flexion tests, nerve blocking, and
radiographs can be performed
2. Magnetic resonance imaging (MRI) can be useful in some cases
E. Management
1. Antiinflammatory drugs
2. Vasodilator (isoxsuprine hydrochloride)
3. Corrective foot trimming and shoeing
4. Last resort: surgically performing a neurectomy

LAMENESS
I. Etiology
A. Wounds/trauma
B. Bone changes include: congenital (e.g., osteochondritis dissecans), chip fragments in joints
resulting from excessive force, stress fractures (star fracture), open fractures, displaced
fractures, avulsion fractures
C. Soft tissue damage include tendon injuries, suspensory ligament injuries, tendon sheath and
joint capsule tears
D. Neurological (e.g., equine protozoal myeloencephalitis)
E. Circulatory disorders (e.g., laminitis)
II. Detailed medical history important
A. Duration of lameness, chronic versus acute, working or stall rested while lame, warms out of
lameness, stumbling, previous medication, alteration in the presentation of lameness while on
medication
III. Methods of diagnosing lameness
A. Visual examination is at rest, walk, and trot
B. Flexion testing to assess joint-specific lameness
C. Palpation of tendons and suspensory ligaments to assess soft tissue lameness
D. Local anesthetics
1. Carbocaine-V 2% injected into soft tissue or intraarticularly
2. Alcohol or antiseptic scrub applied before blocking the area
3. Intraarticular blocks are evaluated after 30 minutes; 60 minutes may be needed for
stifles and shoulders
4. Nonarticular blocks are evaluated after 5 to 15 minutes
5. Ensure that horse is properly restrained before veterinarian injects the local
anesthetic
6. Horse is not sedated for this procedure to accurately diagnose an effect
7. Horse is assessed at walk and trot, canter, and possibly under saddle before and after
blocking, preferably with the same person handling or riding the horse
8. For an excited horse that is difficult to handle, acepromazine may be injected
intravenously without masking the lameness
E. Radiographic examination
1. Proper support of the plate is essential, but radiation safety is to be considered
2. Plate held parallel to the leg, with the leg positioned squarely under the horse
3. Lead aprons with thyroid protectors and lead gloves must be worn
4. Dosimeters measure radiation exposure levels
5. Views include:
a. Lateral
b. Dorsopalmar/dorsoplantar (DP)
(1) Views distal to and including the carpus and tarsus
(2) May be referred to as anterior-posterior
c. Craniocaudal (CrCd)
(1) Views proximal to the carpus or tarsus
d. Oblique: medial (MO) and lateral (LO): DPMO/DPLO/CrCdMO/CrCdLO
e. Flexed for fetlock and carpus
f. Skyline of the carpus and stifle
g. Navicular views are taken of the feet with the horse standing on a reinforced
cassette holder
h. Portable units may be used to x-ray feet, fetlocks, carpus, and hocks
i. Larger stationary units with higher milliamperage (mAs) and kilovolt (kV)
used for shoulder, stifle, cervical spine, pelvis, and skull
j. For pelvic radiographs, horse is either anesthetized for dorsal recumbency or
is standing and well sedated
F. Ultrasound diagnosis
1. Tendons: superficial and deep digital flexor tendons
2. Ligaments: check ligament, main suspensory, and medial and lateral branches of the
suspensory
G. Nuclear scintigraphy
1. A radioactive isotope, technetium-99 m, is injected IV into the horse
 a. Three types are used in horses
2. Isotope concentrates in areas of high metabolic activity
3. Soft tissue of the lower limbs is scanned 2 to 20 minutes from injection
4. Then 2 to 3 hours later the body is scanned for hot spots, or areas of uptake
5. The horse is radioactive for 24 to 36 hours, and contact is restricted to feeding and
watering
6. Hind end scans involve withholding water the morning of the scan so the bladder
does not obscure the pelvis
7. Salix parenteral, a diuretic, is injected IV to help minimize bladder size
8. Diagnostic uses
a. History of poor performance with no evident lameness
b. Lameness that does not block out or is multifocal
c. Suspected stress fractures, such as tibial stress fractures, that do not always
show on radiography
d. Bone remodeling
e. Osteoarthritis (degenerative joint disease)
f. Suspected soft tissue injuries to tendons and ligaments
H. Magnetic resonance imaging
1. Highly specialized diagnostic tool using a high-powered magnet
2. Used when a specific area of pain has been localized, but a diagnosis is not
obtainable by traditional methods mentioned previously
3. Creates a more detailed anatomical image and shows physiological changes in tissue
composition, unlike more traditional methods
4. Areas examined, under general anesthesia, are limited to the feet, lower leg
including the carpus and hock, head, neck, and whole bodies of foals
5. The patient should be bathed to keep dirt out of the MRI tube and away from the
magnet
6. Horses shoes must be removed and radiographs taken to ensure there are no
nail fragments present
I. Common causes of lameness include laminitis, navicular syndrome, fractured splint bones,
bucked shins, cortical stress fractures of shins (saucer fractures), chip fractures in joints,
condylar or p1 (first pastern bone) fractures, hoof abscesses, bowed tendons, torn suspensory
ligament

THERAPEUTIC MODALITIES
I. Extracorporeal shock wave therapy
A. Speeds up healing time by increasing blood flow to the area
B. Used on ligaments, shin saucer fractures, bucked shins, and some bone fractures
C. Beginning to be used on navicular
D. Has not been successful in treating tendons
E. May be ultrasound guided
II. Interleukin receptor antagonist protein (IRAP)
A. Autologous therapy used to treat joint inflammation caused by injury or osteoarthritis
1. Not a treatment for chip fractures or osteochondritis dissecans
B. IRAP is a naturally occurring protein that binds to receptors in the injured joint
C. The purpose is to reduce or stop the inflammatory cascade caused by interleukin proteins
bound to the same receptors
D. Collection of IRAP
 1. Whole blood is collected in a specialized syringe containing glass beads
2. The beads cause the red blood cells to produce more of the antagonist protein (IRAP)
3. The syringes are incubated for 18 hours, then centrifuged to collect the IRAP-rich
serum
E. Joint injection procedure
1. Clip the area of the joint to be injected
2. Prep the area using bacteriostatic soap, alcohol, and final germicidal solution
3. Sedate the patient prior to the veterinarian injecting the serum into the joint
4. Sterile technique used when injecting the serum
5. Cover the injection site with a gauze bandage, which is removed after a few hours
III. Platelet-rich plasma
A. Autologous therapy used to treat recent tendon, ligament, and some joint injuries
B. Whole blood is aseptically collected in specialized syringe containing an anticoagulant
1. Anticoagulant is either acid citrate dextrose solution or citrate phosphate dextrose
solution
2. Use 18-gauge needle or larger for blood collection
a. Prevents trauma during blood collection
b. Avoids activating platelets prematurely
C. Centrifuge the whole blood to separate out the platelet-rich plasma
D. Transfer plasma to a sterile syringe for immediate injection into the horse
E. Horse is sedated and a local anesthetic may be injected subcutaneously prior to treatment
F. Therapy used for:
1. Tendons and ligaments using ultrasound guidance
2. Intraarticular joint injection to treat osteoarthritis
3. Wound healing
G. Use prep procedure as described for IRAP therapy

STANDING SEDATION
I. Drug protocols (see Table 25-3)

TABLE 25-3
Sedation and General Anesthesia

Route of
Administration/P
Application Advantages Drugs Commonly Used
hase of
Anesthesia

STANDING SEDATION

1. Standing
sedation
Intravenous (IV) 2. Procedur Advantages: -Agonist only:
2

bolus es of
short
duration
(15-20 1. Rapid effect following IV 1. Detomidine
Route of
Administration/P
Application Advantages Drugs Commonly Used
hase of
Anesthesia

min) administration 2. Xylazine

(e.g., 2. Administer initial low first 3. Dexmedetomidine
joint dose 4. Romifidine
injection, 3. Determine effect and top up
radiogra as necessary
-Agonist followed by opioid:
2
phs)

1. Butorphanol
2. Morphine

Combinations:

1. Xylazine + butorphanol
2. Detomidine + butorphanol
3. Romifidine + butorphanol
4. Detomidine + morphine
5. Xylazine + morphine

Phenothiazine + -agonist 15-30 min

2

later:

1. Acepromazine + xylazine
2. Acepromazine + detomidine

Constant rate Standing Advantages: -Agonist only:

2

infusion (CRI) surgeries

of long
duration
1. Bolus (a loading dose) prior 1. Dexmedetomidine
(> 15-20 to starting CRI 2. Detomidine
min) 2. CRI drug doses are halved
when combining drugs
Opioid only:
3. Dosage rates are easy to
adjust to effect
4. Cumulative effect of drug 1. Butorphanol
allows for lower dosages
over a longer period Combination -agonist + opioid:
2

1. Dexmedetomidine + butorphanol

Epidural Analgesia
anesthesia
of the
perineal
area

GENERAL ANESTHESIA (GA)

Route of
Administration/P
Application Advantages Drugs Commonly Used
hase of
Anesthesia

1. Sedative
drug
Sedation given Advantages: -Agonist alone (see above list)
2

(premedication) prior to -Agonist + opioids

2

administ
-Agonist + phenothiazines
2
ration of
inductio Phenothiazines alone
1. Smoothens induction phase
n drug 2. Allows decreased dose of
Phenothiazines + opioids
2. -
2
induction drugs Phenothiazines + -agonists
2

Agonists 3. Allows decreased dose of

provide inhalant
analgesic 4. 2-Agonists and opioids
propertie provide analgesia
s 5. Improves recovery

Induction Second phase of Advantages: Ketamine

GA Ketamine + benzodiazepine
following (Diazepam)
an -2 Ketamine + benzodiazepine + gu
1. Less -agonist needed
agonist aifenesin (GG)
2

when
ketamine + diazepam or Ketamine + guaifenesin (GG)
ketamine + guaifenesin Tiletamine + zolazepam
(glyceryl guaiacolate Thiopental
[GG]) + diazepam
Thiopental + guaifenesin (GG)
2. Improved relaxation with
both combinations Propofol
Inhalation sedation

Total intravenous Extends Advantages: Combination for short-term:

anesthesia anesthesia
(TIVA) following
induction:
1. Prolongs general anesthesia 1. Ketamine + -agonist
2

without the need for

inhalant anesthetic
Combinations for long-term:
2. Short-term: 5-10 min
1. Short- duration
term 1. Ketamine + xylazine + guaifenesin
3. Long-term: maintains more
with IV 2. Ketamine + detomidine + guaifenesin
stable anesthetic plane
bolus 3. Ketamine + romifidine + guaifenesin
2. Long- 4. Ketamine + dexmedetomidine
term 5. Ketamine + benzodiazepine
with CRI 6. Propofol
Route of
Administration/P
Application Advantages Drugs Commonly Used
hase of
Anesthesia

Maintenance Inhalation Advantages: Isoflurane

anesthetic Halothane
drugs Sevoflurane
maintain
1. Depth of anesthesia can be
GA changed rapidly
2. Minimal drug accumulation
over time
3. Drug elimination is
ventilation dependent
4. Can be used with injectable
drugs

Disadvantages:

1. Pollution of surgery suite

2. Cardiovascular + respirat
ory depression
3. Minimal analgesia
4. Expensive equipment and
inhalant drugs
5. Recovery poor compared to
IV drugs

Partial intravenous Used with Advantages: -Agonists only:

2

anesthesia general
(PIVA) inhalant
anesthetic
1. Less inhalant anesthesia 1. Dexmedetomidine
needed 2. Xylazine
2. Provides increased analgesia
3. Better recoveries
Ketamine
Lidocaine 2% HCl
Combinations:

1. Ketamine + -agonist
2

2. Lidocaine + ketamine
3. Lidocaine + ketamine + xylazine
4. Lidocaine + ketamine + dexmedetom
idine
 II. Surgeries and procedures performed using intravenous bolus
A. Joint injections, regional perfusion to administer antibiotics, placement of chest drains,
radiographs, Caslick's procedure, extraction of wolf teeth (first premolar), castration, eye
exams or placement of a palpebral eye lavage system
III. Surgeries and procedures performed using constant rate infusion
A. Perineal lacerations (+ epidural anesthetic)
B. Repairing rectovaginal tears (+ epidural anesthetic)
C. Laparoscopies: nephrosplenic space closure, ovariectomy, cryptorchidectomy
D. Tendon splitting

EQUINE SURGERY AND ANESTHESIA

I. General anesthesia preoperative preparations
A. Take horse off feed up to 12 hours before surgery. Water can remain
1. Time off feed dependent on surgical procedure
B. Physical exam includes:
1. Temperature, pulse, and respiration; gastrointestinal motility; lung auscultation
C. Preoperative radiographs are dependent on type of surgery
D. Blood gas, electrolyte concentration, and PCV/TP results analyzed
E. Intravenous catheter placed
1. Dependent on recumbency
2. Throat surgeries require catheter placement lower than normal
F. Groom horse
G. Remove shoes (optional); may tape for recovery
II. General anesthesia drug protocols (see Table 25-3)
A. Sedation/premedication
1. First phase administered outside induction area
2. Rinse horses mouth with water once sedated
3. Partial dose given, then increased to effect adequate sedation
B. Induction
1. Second phase when horse becomes recumbent
2. An endotracheal tube (ET) is passed
3. Horse is positioned on surgery table in lateral or dorsal recumbency
4. Surgical site is clipped and prepped
5. Urinary catheter may be placed
C. Maintenance
1. Third phase inhalant anesthesia begins once the ET is in place
2. Partial intravenous anesthetic may supplement inhalant
III. Recumbency
A. Dorsal
1. Positioning
a. Squared on table with head and body aligned
b. Entire length of body must be on the pad
c. Position maintained with use of V supports or hoist and hobbles
d. Keep bony part of tail free of body
2. Limb placement
a. Front limbs rest on pad on sternum and secured to table with rope
b. Hind limbs stay in a relaxed position and must not be extended for long
periods
 3. Padding
a. Shoulders must be well padded
b. Ensure poll is padded
c. Wedge pad may be placed under nasal bones
d. Protect eyes if wedge pad placed under nasal bones
(1) Sterile lubricant placed in both eyes for protection
4. Complications due to incorrect positioning or improper or insufficient padding
a. Bilateral hind limb lameness
b. Overextension of head may cause recurrent laryngeal nerve damage
5. Surgeries performed in dorsal recumbency
a. Abdominal surgeries (e.g., colic, abdominal exploratory, cesarean section,
umbilical and inguinal hernia repair)
b. Laryngeal ventriculectomy, partial arytenoidectomy
c. Castrations, cryptorchidectomy (bilateral or unilateral)
d. Arthroscopies for hock, stifle
(1) Carpus and fetlock: surgeon preference
e. Laparoscopies, ovarioectomy
f. Neurectomy: surgeon preference
B. Lateral
1. Positioning
a. Entire body on padding
b. Head in neutral position, avoiding overextension or overflexion
c. Halter removed to prevent pressure on the facial nerve
d. Lower eye protected with sterile lubricant and lid kept closed
e. Tongue withdrawn upward from mouth
f. Ensure dependent earlobe is free of pressure
g. Penis and bony part of tail not trapped under body
h. Do not put pressure on shoulder or hip by raising limbs off the table
2. Limb placement
a. Dependent front limb pulled forward
(1) Protects tricep muscle from chest wall pressure
b. Limbs maintained parallel to tabletop
c. Hind limbs left in neutral position
3. Padding
a. Elbow and stifle on the body pad
b. Table leg attachments and padding for dependent limbs
c. Do not place padding on top of the dependent limbs
d. Upper limbs supported in padded cup holders
4. Complications due to improper or insufficient padding
a. Facial and radial nerve paralysis
b. Triceps muscle myopathy
5. Surgeries performed in lateral recumbency
a. Eye surgery, tooth extractions, mandible fracture repair (wiring), field drop
castrations, laryngotomy, laryngoplasty, periosteal strips, splint fracture
removal, neurectomy (if more than one branch), condyle fracture repair
b. Arthroscopies of carpus, fetlocks, shoulders
IV. Preparation of surgical site as per small animals
A. Clippers used to remove all hair within 1 hand width of surgical site
B. Prep includes three stages
 1. Minimum 7-minute scrub time or until no debris observed for bacteriostatic first
stage
2. Alcohol and germicidal solution repeated after horse moved into surgical suite
3. Sterile wrap may be placed over prepped limb when moved from induction to
surgery
C. Prepping for eye surgeries
1. Apply sterile lubricating gel to prevent hair from getting into eyes
2. Remove eyelashes and hair around the eye
3. If the eye is being enucleated (removed), the eyelids are sutured closed
4. Bacteriostatic agents should be avoided because they irritate the sensitive tissue
around the eye and can damage the eyeball
5. A very dilute solution of povidone-iodine and saline can be used to clean skin
around the eye
6. When flushing out the eye, saline or a salt-based solution is often used
V. Apply same principles for circulating in surgery as per small animals
A. May assist anesthetist with blood pressure readings, depending on type of monitoring
equipment
1. Systolic blood pressure should be above 80 mm Hg
2. Dobutamine used to increase blood pressure; side effect is to lower heart rate
VI. Recovery
A. Recover in same recumbency as during surgery
B. When in dorsal recumbency for surgery
1. Left lateral recumbency is preferred to right recumbency for recovery
C. Head is protected with padding; recovery helmet or pad between halter and cheeks
D. Legs may be wrapped for protection
E. If shod, use tape to cover the shoe during surgery and recovery
F. Endotracheal tube is tied in place. May switch to a tube with no cuff in case horse chews the
tube during recovery
1. Assisted recovery: ET tube is pulled when horse swallows
2. Unassisted recovery: ET tube is pulled once horse is standing
VII. Postoperative care
A. After the horse recovers and is stable, it can be moved back to its stall
B. Horse should be kept warm and quiet
C. Feeding regimen is clinic specific and determined by the type of surgery
D. Monitoring horses feces is very important, because ileus is a risk with general anesthetic
E. Horses vital signs, including gastrointestinal motility, are monitored twice daily
F. After horse passes feces, soft food such as a small bran mash can be introduced. A few hours
later, a small amount of hay can be fed
G. If horse passes more feces and vital signs are normal, horses regular feeding schedule
can be slowly introduced, beginning with gradually increasing amount of hay fed
H. If horse does not pass any feces, a veterinarian will perform a rectal examination to
determine if horse is impacted
1. If impacted
a. An NG tube is passed, and warm water, mineral oil, and/or salt is
introduced into the stomach to help break down the impaction
b. Food is withheld from the horse
c. Horse may be placed on intravenous fluids (LRS) until passing feces
d. Frequent hand walking (if surgery allows)
2. Monitor vital signs
 a. Particular attention is paid to gastrointestinal motility (gut sounds)
b. Horse monitored closely until impaction has passed
I. In cases of arthroscopic surgery
1. Bandage is monitored for fluid discharge
2. Leg is monitored for unusual heat, swelling, or pain
3. Usually 24 hours after the surgery, hand walking for 5 minutes is introduced
J. In cases of fracture repair
1. The cast is monitored for softness and/or strike-through caused by discharge leaking
from the fracture site
2. Note unusual smell coming from the cast
3. Note swelling above the cast
4. On recovery, the cast may be replaced by a firm support bandage (Robert Jones
bandage)
5. This will depend on the severity of the fracture

BANDAGE TECHNIQUES
I. Much damage can be done with a poor bandage
II. Principles of bandaging
A. Smooth and wrinkle free with no bunching of material
B. Adequate thickness of wrap under the bandage is necessary
C. If too loose, it can slip and may constrict the back of the tendon and cause a bowed tendon
(bandage bow)
D. If too tight, it can constrict blood supply to the wound or area distal to the bandage, or cause
a bowed tendon
III. As per small animals (Chapter 24) the three layers include primary layer, secondary layer, and
tertiary or outer layer
IV. Bandage uses
A. Wound protection from trauma and further contamination
B. Fracture support and immobilization
C. Limit hemorrhage
D. Protection during shipping
E. Protection during induction and recovery for surgery
F. Riding
G. Keeping medications in place
H. Stable wraps for support
I. Stable wraps to decrease pitting edema from stocking up
V. Types of wounds and wound bandages
A. Open wounds
1. Wet-to-dry adherent dressing as first layer
2. Acts to debride wound at every bandage change
a. Change once or twice daily until a granulation bed forms
3. After development of granulation tissue, switch to a dry nonadherent dressing as the
primary layer
a. Prevents damage to the granulation bed and epithelium
B. Closed wounds
1. Medicated gauze, usually until first bandage change, depending on whether
discharge present
 2. Next layer is absorbent padding, evenly and smoothly applied to the area being
bandaged and secured with a conforming bandage
3. Depending on area being bandaged, the tertiary layer is Elastic Adhesive Bandage,
Vetrap, or a cotton and bandage
VI. Postoperative bandages
A. As for closed wounds
B. When bandaging the carpus and hock
1. A figure-eight pattern with an elastic adhesive bandage adhering to the hair above
and below the joint
2. Keep pressure off the accessory carpal bone and point of the hock to avoid pressure
sores
3. A standing bandage may be placed below the carpus or hock bandage to keep it from
slipping
4. Keep pressure off tendon to prevent a bandage bow injury
VII. Cast
A. Medicated gauze and absorbent layer held in place with Conform bandage
B. A sterile, nonpervious stockinette covers the leg from the hoof to above the length of the cast
C. Vetcast plaster roll is saturated in warm water and wrapped horizontally and vertically for
strength
D. For short-term casts, Gigli wire may be placed between the nonpervious stockinette and the
cast for ease of removal once the horse is standing
E. Felt may be wrapped at the top of the cast to prevent cast sores from rubbing
F. Long-term casts are removed with a cast-cutting saw and cast spreaders
G. Horses vary in tolerance and reaction to a cast and must be monitored daily
H. Duration of time in a cast depends on the severity of the fracture
VIII. Foot bandage
A. Used to keep medication or poultice in place
B. Animalintex is a manufactured bandage poultice
C. Often left on overnight
D. Are replaced daily
E. Puncture wounds and abscesses are most common reasons for a foot bandage
F. For laminitis; keeps foam pads in place to support the frog and sole of the foot

ACKNOWLEDGMENT
The editors and authors recognize and appreciate the original contribution of Colleen Hill.

REVIEW QUESTIONS
1. What is not true of long-term Mila catheters?
a. Commonly placed into the jugular of neonatal foals
b. Is a catheter-over-guidewire style of catheter
c. Meant to be used for regional perfusions
d. Can be left in place for 3 to 4 weeks

2. When performing nasogastric intubation into the esophagus, you should:

a. Have positive pressure when sucking back or blowing into the tube
b. Be able to see the tube on the right side of the neck while advancing into the esophagus
 c. Elicit a cough/gag response
d. Observe the tube passing along the left jugular groove as it advances down the esophagus

3. What route of infection from Clostridium botulinum causes botulism?

a. Stepping on a nail
b. Being bitten by mosquito
c. Wounds infected with contaminated spores in soil or vegetation
d. Wound abscess

4. Equine proliferative enteropathy (EPE):

a. Is caused by the bacterium Lawsonia surs
b. Causes pneumonia and gastrointestinal tract abscesses in weanlings
c. Is caused by the bacterium Lawsonia intracellularis
d. Both b and c are true

5. Rhodococcus equi causes __________ in foals.

a. Hypoproteinemia
b. Diarrhea
c. Pneumonia
d. Chronic weight loss

6. Which teeth most often require extraction?

a. Canine teeth, called tushes in mares
b. Third molar (M3), located in the lower jaw
c. Second premolar (P2), located in the upper jaw
d. First premolar (P1), also known as wolf tooth

7. What does the term "floating the teeth" refer to?

a. How a horse eats its food
b. Rasping down sharp teeth edges
c. The anatomical structure of the horse's jaw
d. Temporary teeth that foals have

8. Equine herpesvirus 1 (EHV-1) primarily affects the:

a. Retropharyngeal lymph nodes
b. Gastrointestinal tract
c. Reproductive system
d. Musculoskeletal system

9. What is NOT an indication that teeth may need to be floated?

a. Difficulty eating
b. Halitosis
c. Broken teeth
d. Lacerations of the oral cavity

10. When giving intramuscular injections in the neck, which three anatomical structures help form the
"visual" triangle indicating the proper injection site?
 a. Jugular vein, nuchal ligament, shoulder blade
b. Throat latch, jaw, the poll
c. Cervical vertebrae, shoulder blade, jugular groove
d. Nuchal ligament, cervical vertebrae, shoulder blade

11. What is NOT true about colitis?

a. It is an acute inflammatory process of the large colon and cecum
b. In most cases, a cause is unknown
c. Gastric motility can either be hypermotile (increased) or hypomotile (decreased)
d. The bacterium Clostridium botulinum has been implicated as one of the possible causes

12. What is laminitis?

a. Inflammation of the carpus and fetlock joints
b. Inflammation of the sensitive laminae of the foot
c. Infection of the laminae of the vertebral arch
d. When an abscess occurs in the sole of the foot

13. In extreme cases of laminitis, what can occur?

a. The coffin bone rotates distally (downward), and can come through the sole of the foot
b. The horse will be intermittently lame
c. The horse will become anxious and begin to stall walk
d. Degeneration of the navicular bone

14. What are the most common signs of navicular syndrome?

a. Toe pointing; anxiousness; reluctance to move
b. Rock back on the heels; are pyrexic; are depressed
c. Stumbling; have a shortened stride; are intermittently lame
d. Off feed; have bounding digital pulses; have increased heat in the hoof wall

15. Vaccinations are routinely given:

a. Intravenously (IV)
b. Intramuscularly (IM)
c. Subcutaneously (SC)
d. Intradermally (ID)

16. Which disease is NOT vaccinated for routinely?

a. Rabies
b. Tetanus
c. Eastern/western equine encephalomyelitis (EEE/WEE)
d. Equine infectious anemia

17. Some side effects to vaccinations can include:

a. Generalized muscle pain; mild lethargy; mild fever
b. Runny eyes; nasal discharge; colic
c. Laminitis; off feed; diarrhea
d. Head shaking; sweating; anxiousness
 18. What is NOT true about hyperkalemic periodic paralysis?
a. It is a genetic mutation found only in quarter horses
b. Affects sodium channels in muscle and the ability to regulate potassium levels in the blood
c. It is curable by feeding a diet high in protein and potassium
d. Horses can have violent and uncontrollable muscle fasciculation

19. Potomac horse fever is

a. A Lyssavirus, and the vector is the infected saliva from raccoons, foxes, or skunks
b. Caused by Neorickettsi risticii, and the vector is aquatic insects and freshwater snails
c. Caused by a protozoan found in opossum feces
d. Caused by the bacterium Coccobacillus found in the soil

20. Three main modes for transmission of equine influenza A are:

a. Fomites, aerosolization, secretions from a cough
b. Ingestion of contaminated feces, spoiled food, whole blood
c. Open wounds, umbilicus, surgical incisions
d. Aquatic insects, birds, mosquitoes

CHAPTER 26

Large Animal Nursing, Surgery,

and Anesthesia
RUMINANT, SOUTH AMERICAN CAMELID, AND SWINE
NURSING
Breed Identification
As with small animals, it is important to be able to distinguish between the various breeds of each species of
food and fiber animals. Within large animal species, there are different characteristics that are specific to breed
type and purpose (Table 26-1). Providing colored pictures of each breed is beyond the scope of this
chapter; however, most breeds have an online registry and provide images of their breeds along with the
general characteristics desired for each registry. An excellent site is the Breeds of Livestock available through
the Oklahoma State University web site: www.ansi.okstate.edu/breeds.

TABLE 26-1
Breed Identification
Species Type Breeds

Bovine Dairy Ayrshire, Brown Swiss, Guernsey, Holstein, Jersey, Milking Shorthorn

Beef Angus, Beefmaster, Belgian Blue, Belted Galloway, Brahman, Charolais, Corriente, Gelbvieh,
Hereford, Highland, Limousin, Piedmontese, Pinzgauer, Santa Gertrudis, Shorthorn,
Simmental, Texas Longhorn, Waygu

Caprine Dairy Alpine, LaMancha, Nigerian Dwarf, Oberhasli, Saanen,Toggenburg

Meat Boer

Fiber Angora

Companion Pygmy

Porcine Chester White, Duroc, Hampshire, Landrace, Poland China,Vietnamese Potbelly, Yorkshire

Ovine Meat Barbados Blackbelly, Dorper, Suffolk

Fiber Booroola Merino, Border Leicester, Cheviot, Columbia,Finnsheep, Rambouillet, Targhee

DualPurpos Corriedale, Dorset, Hampshire, Icelandic, Jacob, Lincoln,Polypay, Romney, Southdown

e
Methods for Animal Identification
I. Permanent Identification
A. Branding: hotelectric or fire heated
1. Most commonly used with cattle
2. Animal is restrained, hot iron is placed on specific area of the body and hide is
burned
3. Branding iron takes less contact time and leaves a more clear brand if area is clipped
first
B. Branding: freeze
1. Copper or bronze branding iron, thick with a slightly domed surface
2. Liquid nitrogen or alcohol and dry ice
3. Clipping of fur is important
4. Contact time of freezing iron between 30 to40 seconds
C. Ear tags
1. Metal tags, button tags front/back, panel tags/button, electronic tags
2. U.S. Department of Agriculture (USDA) Premises tags or Canadian Cattle
Identification Agency (CCIA) Radio Frequency ID tags
D. Ear Notching with metal ear-notching pliers (see Web Fig. 26-1)

WEB FIGURE 26-1 Metal ear notching plier. Applies notches to ears for identification or to obtain tissue samples for bovine
viral diarrhea virus testing with polymerase chain reaction. (Courtesy Shirley Sandoval.)
 E. Neck tags
1. Plastic chain with tag, web collar with interchangeable numbers, neck band
F. Microchips

Physical Examination
I. Observations
A. Use all senses when performing a physical examination
B. Before entering a stall or pen, helpful information can be obtained by observation
1. Note: eyes, stance, carriage, body condition, urination, defecation, food and water
intake
2. Describe what is normal for each type of animal. For instance, if you are used to
observing beef animals, a dairy cow may look underconditioned, but her weight is
actually optimal
II. Physical examination
A. The physical examination should be consistent
B. Proceed from nose to tail, listening to heart, lungs, and abdomen on both sides of the animal
C. Take note of swellings, abrasions, discharges, etc.
D. Temperature, pulse, and respiration should fall within normal ranges (see Web Appendix E)
E. Rumen or compartment 1 (in South American camelids) contractions should be noted by
listening with a stethoscope at the left paralumbar fossa
1. Normal rumen motility is two to four contractions per minute; SAC compartment 1
motility is three to five contractions per minute
F. Palpate over the ribs, vertebral column, and pelvis of fiber animals. What may appear to be a
well-muscled to overweight animal may actually be a malnourished, emaciated animal
hidden under the fiber
G. Mucous membranes should be pink, with a capillary refill time of less than 2 seconds.
Examine the conjunctiva or vulvar mucosa in animals with dark-pigmented mucous
membranes

Administering Medication and Sample Collection

I. Oral dosing (per os)
A. Balling gun
1. Boluses, capsules, and magnets can be administered using this device, which may be
made of plastic or metal (Figure 26-1)
FIGURE 26-1 Oral dosing equipment. A, Balling guns. B, British capsule forceps. (Courtesy Shirley Sandoval.)

2. Ruminants should be secured and the head well restrained

a. Hold the animal around the bridge of the nose, place your fingers in the
interdental space, and apply pressure to the hard palate
b. This will force the animal to open its mouth so you can introduce the balling
gun at the interdental space
c. Position it so the medication will be deposited at the base of the tongue
d. The head should be stabilized and held horizontally
3. In pigs, a bar speculum can be introduced into the animals mouth to hold the
jaws open so that the balling gun can be used to deposit boluses or capsules at the
base of the tongue (Figure 26-2)
FIGURE 26-2 Oral bar speculum for holding open the mouth for oral dosing or examination. (Courtesy Shirley Sandoval)

B. Stomach tube
1. For delivering large volumes of liquid medication, oral fluids, or anthelmintics or for
transfaunation
2. Frick speculum
a. Hollow, stainless steel tube that is used in cattle; it is inserted similarly to the
balling gun (Figure 26-3)
(1) Used as a guide when introducing a stomach tube to prevent the
tube from being damaged

FIGURE 26-3 Frick speculum for passage of orogastric tubes. (Courtesy Shirley Sandoval.)

b. In sheep, goats, and camelids, a tape roll or appropriately sized, smooth-

ended syringe case can be used
3. Measure the distance from the nose to the rumen at approximately the thirteenth rib
and insert the tube through the speculum up to the mark
a. You may detect the odor of rumen or C-1 gas to let you know you are in the
correct place; visualization of the tube passing down the neck, palpation of
the tube in the esophagus AND the trachea; or have someone listen over the
rumen or C-1 at the paralumbar fossa with a stethoscope as you blow air
into the tube
(1) A gurgling sound will be heard
b. After you verify correct placement, the liquid can be administered either via
pump or funnel (Figure 26-4)
FIGURE 26-4 Instruments to pump fluid for oral fluid administration. A, Metal fluid pump. B, Metal dose syringe. C, Plastic
bilge pump. (Courtesy Shirley Sandoval.)
c. Always kink off the tube or occlude the end before removing it to prevent
the animal from aspirating any of the contents
4. Rumen or C-1 fluid sampling
a. Pass the tube as just mentioned, and siphon fluid out of the rumen or C-1 by
attaching a dose syringe to the end of the stomach tube (Figure 26-4)
(1) Alternatively, while the tube is in the rumen, move the tube
quickly in and out a few times, approximately 8 to 10 inches, and
occlude the end before removing the tube
(2) This process may have to be repeated to obtain an adequate sample
b. Pour the sample into a clean specimen container from the fluted end of the
stomach tube
(1) Passing your sample through the end of the tube that is
contaminated with saliva will change the pH of your sample
C. Drench
1. Small amounts of liquid medication can be given via drenching
2. A dose syringe or unbreakable bottle is placed in the interdental space (ruminants)
or at the commissure of the mouth (swine) (Figure 26-4)
a. The head is tilted slightly so the nose is level with the eye
b. The liquid should be given at a slow rate to allow the animal to swallow
D. Calf feeder
1. All-inclusive oral administration system that includes the fluid bag and oral
administration tubing (see Web Fig. 26-2)
a. Back calf into a corner between your legs
b. Pass the ball of the esophageal calf feeder into the mouth via the dental
space, holding the nose up; pass the ridged tube into the esophagus
c. Administer fluid
d. Clamp off the tubing before withdrawing
WEB FIGURE 26-2 All-in-one esophageal calf feeder: fluid bag, tubing, and stiff esophageal tube. (Courtesy Shirley Sandoval.)

Venipuncture
I. Bovine
A. Jugular vein is for sampling and administering fluids
1. Head is restrained in a head catch and the nose is drawn upward and secured to the
side
2. Injection site is cleansed with 70% alcohol and occluded
3. A 14-, 16-, or 18-gauge, 3.75- to 7.5-cm (1- to 3-inch) needle is used and pushed
with one sharp motion through the skin at a 45- to 90-degree angle
a. The larger bore and longer needle length are used for administration of
fluids
b. Administration of fluids is commonly performed with the needle directed
down the vein; sample collection is performed with the needle directed up
the vein
B. Tail vein (ventral coccygeal) is for sampling and injecting small volumes of nonirritating
substances
1. Confine animal to an area to prevent sideways movement and bend the tail directly
forward at the base
2. Cleanse with 70% alcohol
3. Use an 18- to 20-gauge, 2.5- to 3.75-cm (1- to 112-inch) needle inserted at a 90-
degree angle on the midline between the hemal arches of the fourth to seventh
coccygeal vertebrae
C. Milk vein (subcutaneous abdominal) forms hematomas easily and is under pressure. Use
caution
1. Occlusion is not necessary before entering with a 14-gauge, 5- to 7.5-cm (2- to 3-inch)
needle
2. Digital pressure applied for several minutes is necessary, but a hematoma may still
form
II. Small ruminants and South American camelids
A. Jugular vein is almost always used
1. Direct an 18- or 20-gauge, 2.5- to 3.5-cm (1- to 11 2-inch) needle into the jugular
furrow at approximately a 30- to 45-degree angle
2. Cephalic and femoral veins are uncommon
III. Porcine
A. Cranial vena cava for a large volume (right side preferred because the phrenic nerve and
thoracic duct are found near the left external jugular vein)
1. An 18- or 20-gauge, 7.5- to 10-cm (3- to 4-inch) needle is used for adult pigs
2. The jugular fossa near the manubrium sterni, a bony projection just lateral to the
ventral midline and cranial to the forelegs, is used as a guideline
3. The needle is inserted perpendicular to the plane of the neck and toward the left
shoulder
B. Caudal auricular (ear) for small volumes
1. An 18- to 22-gauge, 2.5- to 3.75-cm (1- to 112 -inch) needle is usually used with
slight negative pressure maintained on the syringe
2. A 19- or 21-gauge butterfly is commonly used for intravenous administration
IV. South American camelids
A. Jugular vein is almost always used
1. Direct an 18- or 20-gauge, 2.5- to 3.75-cm (1- to 112-inch) needle into the jugular
furrow at a 30- to 45-degree angle
B. The jugular furrow lies medial to the ventral transverse processes of the cervical vertebra (see
Web Fig. 26-3)
WEB FIGURE 26-3 Freeze-dried cross section of an adult female alpaca neck; note the thickness of the skin (arrow). A,
Carotid artery; E, esophagus; L, ligamentum nuchae; P, transverse process; S, spinal cord; T, trachea; V, jugular vein.
(Courtesy Shirley Sandoval.)
C. Recommended using cervical vertebrae 2, 5, or 6 as landmarks for venipuncture

Injections
I. Intramuscular
A. Where possible, avoid this route in meat-producing animals. If the drug must be
administered via this route, it should be placed cranial to the shoulder in the neck muscles,
because the blemished tissues can be easily trimmed and discarded if necessary. Current
studies show that some antibiotics have a more favorable bioavailability of therapeutic levels
when administered in this area
B. Needle gauge should be dictated by the viscosity of the substance being injected
C. Bovine
 1. The location is in the lateral cervical muscles
2. Needle size commonly used for adults is 16, 18, or 20 gauge, 3.75 to 5 cm (112
to 2 inch) with 15 to 20 mL maximum volume of medication per site
3. Smaller gauge needles used for calves and up to 10 or 15 mL per site, depending on
the size of the calf
4. When giving intramuscular injections to cattle, it is customary to place the needle
before attaching the syringe
a. A couple of slaps with the flat part of the fist before inserting the needle
tends to desensitize the area and allows the animal to steady itself before the
needle is inserted
b. Aspirate before injecting to ensure needle placement is positioned
intramuscularly
D. Small ruminants
1. Give in the lateral cervical muscles
a. Use 18- to 20-gauge, 3.75-cm (112-inch) needle for adults and 20- to 22-
gauge, 2.5-cm (1-inch) needle for young animals
b. Depending on the size of the animal, the average volume for adults is 5 to
10 mL with a maximum of 15 mL
E. Porcine
1. Dorsolateral neck muscles are best for swine
2. For adult swine, use 18- to 20-gauge, 3.75-cm (112-inch) needle
3. Depending on the size of the pig(let), a maximum of 1 to 15 mL should be
administered
F. South American camelids (not intended for the food chain)
1. Semimembranosus or semitendinosus muscle
2. Quadriceps muscle if cushed
3. Triceps muscle
4. 20-gauge, 2.5-cm (1-inch) needle
5. Adult 5 to 10 mL maximum depending on the size of the animal and the muscle
being injected
II. Subcutaneous
A. As concerns for meat quality assurance increase, this route is becoming increasingly popular
with agricultural animal producers for pharmaceutical administration. There has also been a
marked increase in the variety of pharmaceuticals approved for subcutaneous administration
in food-producing animals
1. Avoid giving products that may be irritating
B. Bovine
1. Site of administration is cranial to the shoulder and the lateral neck
2. Use a 16- to 18-gauge, 3.75 cm (112-inch) needle
a. Volume depends on the personal preference of the veterinarian; however, a
good guideline is up to 250 mL/site in adults and up to 50 mL/site in
calves
C. Small ruminants
1. Site of administration is cranial to the shoulder and lateral neck area or in the axillary
region
2. Use an 18- to 20-gauge, 2.5-cm (1-inch) needle
3. Inject 5 mL maximum/site
D. Porcine
1. Site of administration is the lateral side of the neck, close to the base of the ear
 2. Use a 16- to 18-gauge, 2.5- to 3.75-cm (1- to 11 2-inch) needle
3. Depending on the size of the pig(let), 1 to 3 mL/site maximum
E. South American camelids
1. Site of administration is the axillary region where the fiber is thin
2. 22- to 20-gauge, 2.5-cm (1-inch) needle
3. 5 to 10 mL/site maximum depending on the size of the animal being treated
III. Intraperitoneal
A. Bovine
1. Use a 14- to 16-gauge, 3.75- to 5-cm (112 - to 2-inch) needle
2. Antibiotics usually given in conjunction with rehydration fluids
3. Injection site is the right flank, midway between the last rib and the tuber coxae
a. Go at least 10 cm (4 inches) below the lateral processes of the vertebrae to
prevent retroperitoneal or perirenal injection
B. Small ruminants (neonates)
1. Use an 18- to 20-gauge, 2.5-cm (1-inch) needle
2. Hold the neonate by the forelimbs
3. Place the needle approximately 1 cm (12 inch) to the left of the umbilicus,
aspirate to ensure proper needle placement (not in a vein or bowel), administer
medication or fluids
C. Porcine
1. Use a 16- to 18-gauge, 1.25- to 2.5-cm (12 - to 1-inch) needle in neonates and a 16-
to 18-gauge, 7.5-cm (3-inch) needle in adults
2. Hold the piglet by the rear legs
3. Place the needle between the midline and the flank, aspirate to ensure proper needle
placement, and administer medication or fluids
4. Adult pigs can be standing for administration
IV. Intradermal
A. Used primarily for tuberculin testing
B. Bovine
1. Use a 22-25 gauge, 1.5-2.5-cm (58-1-inch) needle
2. Tuberculin testing requires 0.1 mL of tuberculin to be injected into the dermis of
the caudal tail fold
C. Small ruminants
1. Use a 25-gauge, 1.5-cm (58-inch) needle
2. Tuberculin testing requires 0.1 mL of tuberculin to be injected into the dermis of
the caudal tail fold
D. South American camelids
1. Use a 25-gauge, 1.5-cm (58-inch) needle
2. Tuberculin testing requires 0.1 mL of tuberculin to be injected into the dermis of
the axillary region

Intramammary
I. Mastitis preventive or treatment route
A. Post milking, clean teats with alcohol. Administer one tube of product per teat into the streak
canal
B. To prevent cross contamination, tubes should not be introduced into a second teat

Milk Sampling
I. An important aspect of dairy herd health is early detection and treatment of mastitis. Because of
laboratory costs, milk sampling (for culture) is often performed on a herd basis
II. Milk from groups of cows are batched into a single sample; if the specific batch comes up positive,
then the cows in that batch are individually tested per quarter.
A. Sampling should be done before routine milking or at least 6 hours after milking
1. Each teat should be washed, wiped with an alcohol swab, and allowed to dry
2. Clean in the order of far to near
3. The first part of the stream should be discarded into a strip cup, and a midstream
sample is taken horizontally and directed into the sample vial, which is held
horizontally out from under on the near side of the animal
4. Sampling is done from the nearest side first
B. Determination of subclinical mastitis and a rough estimate of somatic cell count can be done
using an on-site procedure called the California Mastitis Test (CMT)
1. The test kit consists of a paddle with four shallow cups and a reagent containing a
pH indicator (see Web Fig. 26-4)
WEB FIGURE 26-4 A paddle for California mastitis testing; note the four wells for individual quarter sampling. (Courtesy Shirley

Sandoval.)
2. A small amount of milk is mixed with an equal amount of CMT reagent
3. The paddle is gently rotated, and an interpretation is made based on the amount of
precipitation
4. The amount of precipitate formed is given a 0 to 4 rating

Urinary Catheterization
I. Urinary catheterization of male large animals is difficult to impossible because of anatomic structures
A. Urethral process of rams, bucks, and machos
B. Sigmoid flexure of all ruminants, machos, and boars
C. Urethral diverticulum of ruminants and machos
II. Urinary catheterization of female agricultural animal, although not common, is possible
A. For cows the procedure is similar to that in mares
B. For small ruminants follow the procedure as for the bitch

RUMINANT, SOUTH AMERICAN CAMELID, AND SWINE

DISEASES
Metabolic Diseases
I. Hypocalcemic parturient paresis (milk fever)
A. Incidence
1. The incidence of milk fever in cattle increases in high-performing animals at 5 to 9
years of age
2. Greater in Channel Island breeds (Jersey)
3. Usually occurs at 48 to 72 hours postpartum
4. Milk fever in sheep is most common in late pregnancy but can occur in early
lactation
5. The condition is rare in sows but may occur within a few hours of farrowing
6. Although not common, hypocalcaemia has been reported to occur periparturient in
South American camelids
B. Serum calcium level is decreased; serum magnesium level may be increased (flaccid
paralysis) or decreased (tetany)
1. Low serum phosphorus level may be a contributing factor
C. Clinical signs initially include muscle tremors, weakness, and staggering gait
1. Classic signs include sternal recumbency, head turned into flank, anorexia, dry
muzzle, atonic rumen, increased heart rate (with decreased intensity of heart sound),
mydriasis, myositis, and nerve damage if animal is down too long
2. If left untreated, depression of the circulatory system and bloat as a result of lateral
recumbency will be fatal
D. Characteristically, treatment with intravenous calcium borogluconate gives a quick positive
response
1. Careful attention must be paid to the heart during infusion, because calcium salts
affect the heart muscle
2. Animals should be fed a ration high in phosphorus and low in calcium during the
later stages of pregnancy during the dry period
II. Ketosis (acetonemia in cattle; pregnancy toxemia in ewes, does, and camelids)
 A. Can occur in the period from just after calving until peak lactation in the cow (2 to 6 weeks
after calving)
B. Lambing paralysis generally occurs in the last trimester of pregnancy in ewes and does
especially if carrying twins or triplets
C. Can occur periparturient in camelids
D. The dam has a negative energy balance because of an increased demand of glucose for milk
production (in high-producing cows) and the demands of the developing fetus (or fetuses)
1. Body fat is mobilized to provide energy
2. Ketone bodies are produced in excess of tissue needs and clinical ketosis results
E. Ketosis may be secondary to any underlying disease that causes in appetence
F. There is a characteristic acetone odor to the breath, milk, and urine
G. Two forms of the disease may manifest
1. Wasting form is more common
a. The cow may begin by being off grain alone, then silage, but may continue
to eat hay
b. Weight loss exceeds what one might expect from loss of appetite alone
c. Milk production declines
2. Nervous form presents acutely with head pressing, delirium, teeth grinding, and
staggering
a. In ewes and does, signs of the disease are more like the nervous form, and
ketones may be detected on the breath
3. Camelids have a predilection toward hepatic lipidosis
H. Treatment
1. Intravenous infusion of glucose (dextrose) is usually successful in cows, although it
often needs to be repeated
2. Oral doses of propylene glycol and hormonal therapy may be useful
3. The same treatment in ewes is less satisfactory
4. Lambs may have to be removed by cesarean section to save the ewe
5. Most incidences of ketosis can be prevented by adhering to a careful management
and ration plan (see Chapter 14 for further information)
III. White muscle disease (nutritional myodegeneration)
A. Vitamin E and selenium deficiency is seen in young, rapidly growing calves, lambs, kids,
and cria
B. Most commonly, these animals are from dams that were on selenium-deficient and Vitamin E
diets during their pregnancy
C. It manifests in two forms: cardiac and skeletal
1. The cardiac form presents with severe debilitation or sudden death
2. Clinical signs include depression, respiratory distress, pulmonary edema, foaming at
the mouth, swollen painful muscles, stiffness, and weakness
3. The skeletal form presents with weakness or muscle stiffness; the animal may
become recumbent. Muscle groups in the limbs may become hard and painful on
palpation
4. For prevention of this disease, supplement the diet with an injection of vitamin E
and selenium
5. Injections can be administered to neonates following labeled instructions

Alimentary
I. Displaced abomasum
A. Left displaced abomasum (LDA)
 1. Occurs when the abomasum is displaced from its normal position on the abdominal
floor to the left side of the abdomen, between the rumen and the abdominal wall
B. Most common in large-frame, high-producing, mature dairy cows immediately after calving
1. Clinical signs are decreased appetite, lower milk production, decreased rumen
motility, intermittent diarrhea, secondary ketosis, and the presence of a ping in the left
flank caused by the entrapment of gas
2. Surgical correction is performed using a left paralumbar (abomasopexy or
omentopexy), right paralumbar (omentoabomasopexy or omentopexy), or ventral
paramedian (abomasopexy-open or abomasopexy-toggle) approach
C. There is an increased incidence of displaced abomasum in cows fed a high-grain diet (zero
grazing) in conjunction with confined housing
II. Right displaced abomasum (RDA)
A. This is an emergency
B. Occurs within a few weeks of calving and may be complicated by right-sided torsion of the
abomasum (RDA)
C. Less common than LDA, but clinical signs are similar
1. Abomasal torsion will present with acute, severe abdominal pain and acute signs of
toxicity; death may occur without a timely correction
2. Surgical correction is made using right flank (omentoabomasopexy or omentopexy)
or ventral paramedian (abomasopexy-open) laparotomy
D. Preventive measures include feeding adequate long-stem forages and avoiding moldy feeds
III. Vagal indigestion
A. Characterized by anorexia, decreased movement of ingesta through the stomachs, and
distention
B. Vagal indigestion is broken down into four types
1. Affects primarily cattle and is less often in sheep
C. Type I vagal indigestion
1. Free gas bloat due to inability to eructate
2. Multiple causes that result in inflammation to or near the vagal nerve, including
traumatic reticuloperitonitis (hardware disease) (see Web Fig. 26-5)
a. Hardware disease usually results from perforation of the reticulum and
sometimes the rumen by an ingested foreign object
b. Clinical signs are a sudden decrease in milk production, anorexia,
hunching, and groaning
c. Often the cow will grunt if pressure is applied over the xiphoid (grunt
test)
d. Rumen becomes atonic, fecal output is decreased, and ketosis often occurs
e. Treatment includes antibiotics and placing a magnet into the reticulum
f. If unsuccessful, a rumenotomy may be performed
g. Because dairy cattle are most often affected, most cases can be prevented by
the administration of a bar magnet to all heifers at 6 months of age and
careful adherence to debris-free forage
WEB FIGURE 26-5 Two types of cow magnets that are given orally to prevent hardware disease. (Courtesy Shirley Sandoval.)

D. Type II vagal indigestion

1. Failure of omasal transport
2. Common causes include omasal canal obstructions such as abscesses, foreign bodies,
adhesions, or tumors
E. Type III vagal indigestion
1. Abomasal impaction resulting from decreased water intake and short fiber length of
dry feed matter
2. Secondary to a displaced abomasum
F. Type IV vagal indigestion
1. Forestomach obstruction
2. Gestational sequela when the uterus interferes with normal rumen movement
G. In sheep the cause may be peritonitis resulting from sarcosporidia
IV. Ruminal tympany (bloat)
A. Bloat is an acute overdistention of the rumen in the form of free gas or froth mixed with
ingesta
1. Frothy bloat occurs in cattle on legume pasture and on high-grain diets
a. The froth produced prevents the escape of normal gases during eructation
2. Gas bloat is caused by a physical obstruction of the gases and a failure of eructation
B. If the bloat is not life threatening, the passage of a large-bore tube (Kingman) into the rumen
to allow the escape of gas may be sufficient
C. If the bloat is severe, the distention causes compression of the diaphragm and the animal is
unable to breathe
1. An emergency rumenotomy may be necessary to save the animal (Figure 26-5)
FIGURE 26-5 Rumen trocar, plastic screw type, used to create an emergency rumenotomy to relieve the pressure of bloat.
(Courtesy Shirley Sandoval.)
2. The left paralumbar fossa can be incised using a sharp knife or a trocar and cannula
3. Antifermentive and antifrothing agents are usually administered
4. Frothy bloat can be controlled to some degree by careful pasture and feed
management
V. Rumen acidosis (grain overload)
A. Grain overload is an accumulation of excessive quantities of highly fermentative
carbohydrates that produce lactic acid in the rumen
1. As lactic acid increases, rumen pH may drop below 5.0 and metabolic acidosis occurs
2. Bovines, caprines, and ovines are affected
3. Usually occurs from accidental access to large quantities of grain. Preventive
measures include limiting or balancing concentrate intake with forage intake
 4. Clinical signs include severe toxemia, weakness, dehydration, fluid-filled static
rumen, incoordination, and recumbency, leading to death
B. Principles of treatment include decreasing fermentation and acid production in the rumen
using antimicrobials, neutralizing metabolic acidosis, and rehydrating the animal using
intravenous fluids with sodium bicarbonate
C. Compartment 1 acidosis occurs in South American camelids
VI. Neonatal diarrhea
A. An important disease of farm animals; it has multiple infectious and noninfectious causes
1. Stresses such as cold weather, changes in diet or housing, weaning, and failure of
passive transfer of maternal gamma globulins from colostrum predisposes neonates to
infection
2. Absorption of immunoglobulin G occurs optimally in calves within the first 6 to 8
hours of life, but may occur up to 24 hours
a. Kids up to 24 hours
b. Lambs, maximally to 15 hours, but up to 24 to 48 hours
c. Piglets up to 12 to 24 hours
d. Crias up to 24 hours
3. Dietary diarrhea can be due to ingestion of increased quantities of milk or inferior
milk replacers
B. Diarrhea is characterized by profuse, watery, yellow feces; dehydration; metabolic acidosis;
shock; and death
C. Successful treatment of diarrhea depends on cause and duration
1. Replacing fluid and electrolytes lost and correcting metabolic acidosis should be the
main objectives
D. Infectious causes of neonatal diarrhea can be controlled with a vaccination regimen and
provision of good-quality colostrum
E. Bovine
1. Escherichia coli diarrhea
a. Clinical signs include dehydration, acidosis, weakness, and death
b. Treatable if caught early
c. Vaccine available
F. Small ruminants
1. Rotavirus
a. Causes mild diarrhea
b. Recovery usually in a few days
c. Mortality rate increases when animal is also infected with E. coli
G. Porcine
1. Swine dysentery (Treponema hyodysenteriae)
a. Causes depression, weakness, anorexia, hemorrhagic diarrhea, and
sometimes death
b. Can be treated, but symptoms may return after initial treatment is
discontinued
c. Effective vaccines are not available, but there is current research for the
development of biological protection for this disease
2. Transmissible gastroenteritis (porcine rotavirus)
a. Common viral disease in swine
b. High morbidity and mortality rates in piglets younger than 10 days
c. Clinical signs include diarrhea, vomiting, anorexia, dehydration, and death
d. Vaccination available
 3. Porcine epidemic diarrhea virus (PEDV) (porcine coronavirus)
a. Similar to TGE
b. No vaccine currently available in North America
H. South American camelid
1. Treatment, coccidiostat and supportive
2. Clostridium perfringens type A
a. Bacterial disease
b. Sudden onset of diarrhea, lethargy,
c. High morbidity and mortality
d. Vaccination, extra-label cattle product
3. Eimeria spp.
a. Parasite: oocyte
b. Causes diarrhea by damaging the intestinal lining, preventing absorption of
nutrients and fluids. Also causes excretion of fluids
c. Promotes dehydration, ill thrift, and possible death

Reproductive
I. Bovine
A. Mastitis
1. An inflammation of the mammary gland can occur in all species, but assumes
economic importance only in milk production species
2. A large proportion of cases are subclinical and can be detected only by screening
tests based on the leukocyte count
3. Clinical mastitis is characterized by heat, pain, and swelling of the gland, and
marked changes in the milk, such as discoloration and clots
4. A few of the major bacteria involved are Staphylococcus aureus, Streptococcus agalactiae,
and some of the coliform bacteria
5. Treatment must include removal of infection from the quarter and returning the milk
to its normal composition
6. Several treatments are available and depend on the severity of infection
a. Includes frequent milking out of the infected quarter (stripping), udder
infusions, systemic antibiotics, and perhaps drying off of the infected quarter
(i.e., not milking it)
7. Prevention of mastitis through a prophylactic routine of regular screening, proper
milking technique, maintenance of milking equipment, and early recognition and
treatment of subclinical cases is the best course
8. Agent-specific vaccines are available for cattle
B. Vibriosis (Campylobacter fetus ssp. venerealis)
1. Zoonotic
2. Spread through herd by infected bull
3. Causes infertility in cows and heifers and a prolonged diestrus period
4. Periodic midgestation abortion
5. Vaccine available
C. Brucellosis (Brucella abortus), Bangs
1. Zoonotic
2. Cows
a. Spread through contact with infected animals, abortive fluids, milk, and
vaginal secretions
b. Causes mid- to late-term abortions (5 + months)
 c. Subsequent pregnancies may be term or end with abortions
d. Metritis (uterine inflammation)
e. Retained placenta
f. Bacterin available to heifers for calfhood vaccination: RB 51; must be given
by a federally accredited veterinarian
g. Some states accept adult vaccinates
h. Reportable disease
i. Eradicated from Canada
3. Bulls
a. Orchitis (inflammation of the testis)
b. Epididymitis (inflammation of the epididymis)
c. Infertility
D. Leptospirosis (Leptospira pomona)
1. Zoonotic
2. Shed in urine and abortus of infected animals
3. Environmental contaminate for weeks to months depending on the dampness where
animals are housed
4. Clinical signs in adult cattle include fever, anorexia, agalctia, abortion, and mastitis
5. Clinical signs in calves include septicemia, pyrexia, anorexia, depression, hemolytic
anemia, and dyspnea
6. Bacterin available
E. Listeriosis (Listeria monocytogenes)
1. Zoonotic
2. Seasonal disease, most common in cooler months, incidence increases when animals
are fed silage or are intensely managed
3. Most commonly found in ruminants
4. Clinical signs in adults include abortion in the last trimester, encephalitis,
ophthalmitis (inflammation of the eyeball), and uveitis (inflammation of the uvea)
5. Bacterin available
F. Neosporosis (Neospora caninum)
1. Protozoal infection
2. Affects bovine, small ruminants, and camelids
3. Abortion at 3 to 8 months of gestation
4. Perinatal death
5. Encephalomyelitis in congenitally infected calves
6. Economically important, causing decrease in overall milk production in dairy cattle,
and increase in culling rate
G. Infectious bovine rhinotracheitis (IBR)
1. Bovine herpesvirus 1
2. Abortion, mummification, stillbirth, or weak calves when infected in the last
trimester
3. Vaccination available, modified live and killed
H. Trichonomiasis (Trichomonas fetus)
1. Protozoal infection
2. Sexually transmitted disease
3. Asymptomatic in bulls
4. Abortion or fetal reabsorption
5. Infertility in cows
6. Polymerase chain reaction test of bull prepucial scrapings
II. Ovine
A. Vibriosis (Vibrio fetus) (Campylobacter fetus ssp. fetus)
1. Zoonotic
2. Infection is from contaminated food or water
3. Clinical signs include abortion, which occurs in the last 6 weeks of gestation
4. May see stillbirths and weak lambs
5. Ewes usually survive, but the viability of the ewe decreases with complications, such
as retention of fetuses, peritonitis, and metritis
6. Vaccine available
B. Brucellosis (Brucella ovis)
1. Ewes (clinical signs include abortion, stillbirths, and weak lambs)
2. Rams (infertility as a result of poor-quality semen and epididymitis)
C. Listeriosis (Listeria monocytogenes)
1. Also known as circling disease, it is classified into three forms: neurologic disease,
abortion, and septicemia
2. The most common form in sheep is neurologic disease. L. monocytogenes are gram-
positive, nonsporing coccobacilli
3. Clinical signs include nasal discharge, conjunctivitis, depression, disorientation,
circling, and facial paralysis
4. Pregnant ewes develop placentitis and abort during the third trimester of gestation,
usually exhibiting no other clinical signs
5. Septicemia in lambs is characterized by depression, anorexia, pyrexia, and diarrhea.
They may die in 24 hours
6. In adults, depression, diarrhea, and slight elevation in temperature (102.2 to
106.7 F [39 to 41.5 C])
D. Enzootic abortion in ewes (EAE) (Chlamydophila abortus)
1. A major cause of abortion in sheep and goats, EAE is characterized by abortions in
the last trimester, as well as stillbirths and placentitis
2. The infectious organism is present in the fluids, tissues, and fetuses at the time of
parturition
3. The main transmission of the disease is via ingestion; therefore removal of the
infected tissue is important to prevent spread of the disease
4. Vaccine available
5. Pregnant women should not handle these tissues or the infected animals
E. Q fever (Coxiella burnetii)
1. Zoonotic
2. Causative agent: rickettsia
3. Placentitis, stillbirth, or abortion in late gestation
4. Organism in high concentrations in the placenta and fetal fluids, also in raw milk
5. Transmitted by inhalation or ingestion
III. Porcine
A. Leptospirosis (Leptospira. pomona)
1. Zoonotic
2. Stillbirths or abortion in the last 2 to 4 weeks of gestation
3. Term piglets may be dead or weak and die shortly after birth
4. In its acute form, it may also cause septicemia in piglets
5. Vaccine available
IV. South American camelid
A. Listeriosis (L. monocytogenes)
 1. Causes abortion
2. Encephalitis, neurological signs, and recumbency
B. Leptospirosis
1. Zoonotic
2. Can cause abortion
3. Symptoms similar to those of cattle or sheep
C. Chlamydiosis
1. Zoonotic
2. See enzootic abortion in sheep

Respiratory
I. Bovine
A. Bovine respiratory disease complex
B. Infectious bovine rhinotracheitis (IBR) (viral), also known as red nose
1. Caused by bovine herpesvirus 1
2. It affects cattle of all ages, but predominantly young feedlot cattle
3. Clinical signs include upper respiratory tract disease, second-degree pneumonia,
enteric disease (< 3-week-old calves), abortion, encephalitis, and infectious pustular
vulvovaginitis
C. Bovine viral diarrhea virus (BVDV)
1. Caused by a pestivirus
2. Bovine viral diarrhea (BVD)
a. Clinical signs: gastroenteritis, diarrhea, respiratory disease, oral lesions, and
abortion
b. Affects cattle 6 to 24 months old
c. Mucosal disease
(1) Clinical signs: oral erosions, lameness, cachexia, and diarrhea
(2) All ages; but mostly young feedlot cattle
(3) Clinical signs of transplacental infection of mucosal disease include
calves born with curly hair coat, weak calf syndrome, and
persistently infected animals
d. Vaccine available
3. Parainfluenza III (viral)
a. Caused by a paramyxovirus
b. Affects all ages of cattle
c. Clinical signs include coughing, fever, nasal discharge, and second-degree
pneumonia
d. Vaccine available
4. Bovine respiratory syncytial virus (BRSV)
a. Caused by a paramyxovirus
b. It is most common in 6- to 8-month-old cattle
c. Clinical signs include cough, nasal discharge, anorexia, and fever
d. BRSV pneumonia causes dyspnea, polypnea, mouth breathing, and
interstitial emphysema
e. Vaccine available
5. Haemophilus somnus
a. Affects 6- to 8-month-old feedlot calves
b. Calves are often unresponsive to treatment
 c. Clinical signs include bronchopneumonia, central nervous system
diseasedepression, ataxia, paralysis, recumbency, septic arthritis,
myocarditis
d. Vaccine available
6. Mannheimia haemolytica and Pasteurella multocida (shipping fever)
a. Affects young animals stressed by weaning or transport
b. Clinical signs include acute toxemic bronchopneumonia, dyspnea, increased
lung sounds, cough, and pleuritis
c. Vaccine available
II. Small ruminants
A. Bluetongue (viral)
1. Transmitted by a midge vector of Culicoides spp.
2. Bluetongue is most commonly found in sheep; less common in cattle and goats
3. A seasonal disease, it presents in the late summer and fall
4. Initial clinical signs include a transient fever with a temperature of 106 F (41 C
or higher), facial edema (including lips, muzzle, and ears), hyperemic mucous
membranes, cyanotic tongue, excessive salivation, and nasal discharge
a. Followed by crusty lesions of the nose and muzzle, and oral cavity lesions,
such as petechial hemorrhage, erosions, and ulcerations
b. This progresses to lameness, cardiomyopathy, and commonly
bronchopneumonia
c. Can also cause the sloughing of hooves, wool break, diarrhea, and death
III. Porcine
A. Porcine reproductive and respiratory syndrome (PRRS, or mystery swine disease)
1. A disease in North America, since the 1980s
2. Characterized by reproductive failure and increased mortality rates in farrowing and
nursery room pigs
3. Reproductive problems include return to estrus, abortion, and delivery of
mummified, stillborn, or poorly viable piglets
4. Increased mortality in piglets is associated with a thumping respiration with
severe interstitial pneumonia and several secondary infectious diseases, such as
diarrhea and septicemia
5. PRRS appears to be spread by movement of pigs between farms and by airborne
dispersion over distances of less than 3 km (1.8 miles)
6. Vaccine available
B. Atrophic rhinitis (Bordetella bronchiseptica, Pasteurella multocida)
1. Atrophic rhinitis is an upper respiratory disease of young pigs
2. The nonprogressive form does not include infection from toxigenic Pasteurella
multocida
a. A less severe disease that is slight to severe, with no transient turbinate
atrophy and no clinical signs
3. The progressive form of this disease includes infection with P. multocida, which
causes sneezing, nasal discharge, shortening or distortion of the nose, and epistaxis
4. Acute cases affect piglets from 3 to 9 weeks of age
a. Severe nasal and maxillary distortion can result in occlusion of the nasal
passages and inability to masticate, resulting in reduced growth rates
C. Porcine pleuropneumonia (Actinobacillus pleuropneumoniae)
1. This disease has a sudden onset
 a. Discovery of dead pigs without previous illness, severe respiratory distress,
and a temperature of 105.8 F (41 C) is common
2. Anorexia, weakness, labored breathing with frothy discharge from mouth and nose
3. Can cause abortion in sows

Other Diseases
I. Bovine
A. Anthrax (Bacillus anthracis)
1. Zoonotic
2. Anthrax spores remain infective in the environment for long periods
3. Reportable disease in the United States and Canada
4. Causes peracute and acute disease
a. Peracute disease causes sudden death
b. Acute disease characterized by staggers, seizures, and death
5. Vaccination available
B. Anaplasmosis (Anaplasma marginale)
1. A rickettsial organism
a. Transmitted from animal to animal mainly via insect vectors but also by
arthropod vectors, mainly ticks
2. Calves usually get a subacute form
a. Clinical signs include bouts of anorexia and intermittent fever and may end
in death; survivors are emaciated with compromised fertility
3. Adults manifest three forms of the disease
a. Subacute is as described for calves
b. Acute disease causes anemia, weakness, pale mucous membranes, and
abortion. These animals may become aggressive and attack caretakers before
death
c. Animals with peracute cases usually die within 24 hours. They initially
present with fever, anemia, and respiratory distress
4. Vaccination available
a. The killed vaccine is not preventive but decreases the severity of the disease
b. Immunity is considered short in duration, at least 5 months
c. Vaccination of breeding cows may predispose calves to neonatal
isoerythrolysis
II. Ovine
A. Contagious foot rot
1. Bacteroides nodosus acts synergistically with Fusobacterium necrophorum as the
causative agents
a. B. nodosus is a gram-negative, anaerobic rod
b. B. necrophorum is a gram-negative, anaerobic coccobacillary rod
c. Clinical signs include varying degrees of lameness in one or more feet,
walking on the knees, or recumbency
(1) The interdigital skin becomes inflamed, and there is slight
undermining of the sole
(2) Removal of the loose hoof emits a distinct foul odor
d. Treatment includes trimming the feet close, exposing the anaerobic bacteria
to air, and copper sulfate foot baths or topical 10% formalin
e. Bacterin available
2. Contagious ecthyma, sore mouth, orf (viral)
 a. Zoonotic disease of small ruminants
b. Affects all ages but is most common in young animals
c. Animals present with crusty lesions on the lips, nose, and gums
d. Older animals usually present with lesions on the udder, external genitalia,
coronary band, eyelids, and conjunctiva
e. Recovery depends on complications that may arise from the initial insult
(1) Complications include second-degree bacterial infection, mastitis,
screwworm infestation, pneumonia, anorexia, and death
f. Bacterin available
III. Porcine
A. Erysipelas (Erysipelothrix rhusiopathiae)
1. Zoonotic
2. This bacterial infection of pigs can manifest in an acute or a chronic form
a. The acute form presents with fever, anorexia, and diamond-shaped skin
lesions
b. The chronic form manifests as arthritis or vegetative endocarditis
c. Incidence is decreased in swine rearing operations where the animals are
housed off soil
(1) Most commonly affects unvaccinated pigs at 3 months to
adulthood
(2) In specific pathogen-free herds, the first signs of disease may be
abortion storms and septicemic death in suckling pigs
B. Meningitis (Streptococcus suis)
1. Zoonotic
2. This bacterial infection occurs in pigs younger than 12 weeks
3. Initial clinical signs include fever, anorexia, depression, stiff gait, blindness, muscular
tremors, and ataxia
a. Followed by recumbency, paddling, and death
4. A more acute disease presents with sudden death
C. Pseudorabies (Aujeszkys disease [viral])
1. Caused by suid herpesvirus 1
2. It is transmitted via oronasal contact with infected pigs
3. The nervous system is the primary site of infection
4. Clinical signs include fever, depression, vomiting, hind limb ataxia, muscle tremors,
paddling, recumbency, coughing, sneezing, and death within 12 hours in young pigs
5. In adult pigs, the disease can cause abortion, stillbirths, and mummified fetuses
6. Vaccination available
IV. South American camelids
A. There are no current biologicals approved for use in the South American camelids; however,
many products are used extra-label for a variety of diseases that affect these species.
1. Bovine viral diarrhea virus, clostridial diseases, West Nile virus, and rabies

RUMINANT, SOUTH AMERICAN CAMELID, AND SWINE

ANESTHESIA
Local and Regional Anesthesia (Analgesia)
I. Local and regional anesthetics are commonly used in large animal practice because they are often
safer and more convenient than general anesthetics; however, attention must be paid to the toxic dose
 levels, with respect to individual species, as well as how they affect slaughter and milk withdrawal
times
A. Local anesthesia is the desensitization of the tissues of the surgical site by the infiltration of
an anesthetic agent at the incision site
B. Regional anesthesia is the desensitization of the surgical site by blocking the nerves that
innervate a region
II. Bovine: regional anesthesia in cattle is commonly used for standing laparotomy. The following
techniques (or a variation) are frequently performed. In every case, the animal is adequately
restrained, the area is clipped and aseptically prepared, and attention is paid to aseptic technique
during anesthetic infiltration.
A. Inverted L block
1. Nerves supplying the paralumbar fossa travel in a ventrocaudal direction from the
spine
2. Local anesthetic is infiltrated in a horizontal line just ventral to the transverse
processes of the lumbar vertebrae and a vertical line just caudal to the last rib
a. The nerves supplying the incision site are blocked
3. A variation of this technique is used for regional analgesia for a ventral midline
approach
B. Paralumbar block (Cornell block)
1. Local anesthetic is injected below the lateral edges of the transverse processes of the
first four lumbar vertebrae
a. The needle is placed horizontally below each process and directed toward
the midline
b. 20 to 25 mL of local anesthetic is injected at each site, using an 18-gauge,
312-inch needle
2. The branches of T13, L1, and L2 (and L3), which supply the surgical site, are blocked
C. Paravertebral block
1. The nerves are blocked as they come off the spinal column (T13, L1, L2, and L3)
a. At a position about 4 cm (112 inch) off the midline, using a long (4- to
6-inch) needle, local anesthetic is injected at the caudal edges of L1, L2, and
L3
2. Muscle relaxation and desensitization of the skin and deeper tissues will result if the
block is successful
D. Epidural block
1. Indications for use
a. To stop straining for obstetrical manipulations
b. To facilitate the reduction of rectal and vaginal prolapses
c. Perineal or udder surgery
d. To stop straining during laparotomy and cesarean delivery
e. Urethrostomies
2. It is achieved by injecting a small quantity of anesthetic agent in the epidural space
between the first and second coccygeal vertebrae (cranial epidural) or the
sacrococcygeal junction (caudal epidural)
a. The area blocked includes the anus, vulva, perineum, and caudal aspects of
the thighs
3. If a larger quantity of local anesthetic is used (high epidural), it may provide 2 to 4
hours of analgesia for laparotomy, limb surgery, teat surgery, etc.
a. The animal will not remain standing
E. Cornual nerve block: used to provide anesthesia for dehorning
 1. The cornual nerve runs along the frontal crest from the lateral canthus of the eye to
the horn
2. The head must be firmly secured and the area clipped and prepared
3. 5 to 10 mL of local anesthetic is injected about halfway along the nerve at the lateral
border of the frontal crest
F. Peterson eye block; for eye enucleation
1. First a skin bleb is made at the point where the supraorbital process meets the
zygomatic arch
a. A 14-gauge, 2.5-cm (1-inch) needle is inserted in the bleb as a cannula
b. An 18-gauge, 12.5-cm (5-inch) needle is inserted through the cannula and
directed past the rostral border of the coronoid process to the
pterygopalatine fossa
(1) Approximately 8.75 to 10 cm (312 to 4 inches) in depth
c. Deposit 15 mL of 2% lidocaine at this site
2. Second, local anesthetic is injected subcutaneously lateral to the zygomatic arch
a. This technique will desensitize the globe and surrounding tissues of the eye
for enucleation
G. Retrobulbar (four point) block: local anesthetic is injected into the dorsal and ventral eyelids
and at the medial and lateral canthi
1. Then approximately 30 to 40 mL of local anesthetic is directed to the nerves at the
apex of the orbit with a curved needle
2. Along with the Peterson eye block, this technique can be used for enucleation or
extirpation of the eye
H. Ring block
1. Local anesthetic agent is deposited subcutaneously and deep into the tissues
completely around the surgical site, as in teat surgery, dehorning, claw amputation,
etc.
I. Vascular infusion for anesthesia of the distal limb
1. Used for digit amputation, hoof and sole surgery, corn removal, and laceration repair
2. Place a tourniquet at mid-metatarsal or metacarpal region
3. Clip and aseptically prepare injection site; identify a surface vein
4. Using a 19- to 20-gauge, 2.5-cm (1-inch) needle or butterfly catheter, insert the needle
intravenously. Aspirate to ensure proper placement
5. Infuse 10 to 30 mL of 2% lidocaine slowly
6. Remove the needle and apply pressure to the insertion site to prevent leakage and
hematoma
7. Remove tourniquet at the end of the procedure
III. Small ruminants and South American camelids
A. Regional anesthesia, such as paravertebral and epidural blocks, can be used in camelids,
sheep, and goats
B. Goats have a lower pain threshold and require sedation
C. Cornual and infratrochlear nerve blocks are used for dehorning goats
1. The corneal nerve is blocked at the caudal ridge of the supraorbital process, 1 to
1.5 cm deep, with 2 to 3 mL of 2% lidocaine (in adults)
a. The infratrochlear nerve is blocked by inserting a needle 0.5 cm through
the skin at the dorsomedial margin of the orbit
b. The nerve may be palpated in some animals
2. Do not exceed a total dose of 10 mg/kg (0.5 mL of 2% solution/kg) because of
toxicity potential
 IV. Porcine
A. The most commonly used regional anesthetic techniques in tranquilized swine are
infiltration, lumbosacral epidural injection, and intratesticular injection
B. Lumbosacral epidural is used for cesarean section, claw amputation, prolapsed rectum
repair, scrotal and inguinal hernia repair, and testectomy
C. Surgical preparation is performed at the injection site
D. Depending on the size of the swine, a 16- to 18-gauge, 3- to 6-inch needle is inserted into the
lumbosacral space
E. Recover in a quiet area, away from other swine, until fully awake and aware of surroundings

General Anesthesia
I. Bovine
A. Bloat and regurgitation of rumen contents, respiratory depression, apnea, and poor
oxygenation are problems associated with general anesthesia in adult cattle
1. Feed should be withheld from cattle before general anesthesia
2. Withhold roughage for 48 hours, grain and concentrates for 24 hours, and water for
12 hours
3. Withhold feed for 2 to 4 hours in preruminant calves
B. Tranquilizers are not usually administered as a preanesthetic, because they do not work well
to calm fractious cattle and violent recoveries are not a problem in cattle
C. An intravenous catheter should be placed in the jugular vein
1. Use 14-16-gauge, 7.5-13.7 cm (3-512-inch) catheter
D. Anesthesia can be induced with a number of drugs, including but not limited to the
following:
1. Propofol
2. Guaifenesin
3. Ketamine and xylazine intramuscularly
4. A mixture of 5% guaifenesin containing 1 mg/mL ketamine and 0.1 mg/mL
xylazine
5. Masking with isoflurane or sevoflurane
E. In a recumbent bovine, bloat and aspiration of regurgitated rumen contents are concerns
1. If possible, position so that the animal is in right lateral recumbency, placing the
rumen up
a. Elevate the poll so the nose is downward. Position so upper front and hind
limbs are parallel to the table surface, pull lower forelimb forward to help
prevent radial nerve paralysis
2. Position in sternal recumbency as soon as possible
3. Keep cuff inflated during extubation
F. A cuffed endotracheal tube should be placed and the cuff inflated, even if inhalants are not
used to prevent aspiration of regurgitated material. Also use a stomach tube for the escape
of rumen gases
1. On induction, a mouth speculum (wedge) is inserted to aid in the introduction of the
endotracheal tube (see Web Fig. 26-6)
WEB FIGURE 26-6 Wedge speculum, used in cattle to keep them from chewing or biting the endotracheal tube during
intubation, anesthesia, and extubation. (Courtesy of Shirley Sandoval.)
G. The surgical table should be covered with protective padding to prevent postanesthetic
complications resulting from nerve paralysis
H. Isoflurane is usually used when inhalation anesthesia is chosen; however, sevoflurane can
also be used
1. At surgical plane, the cattle will have slow regular breathing, a slight palpebral
reflex, and anal reflex
2. The pupil is centered between the upper and lower lids
3. The eye is rotated ventrally and the pupil is rotated medially below the lower lid
when the animal is in a light plane of anesthesia
4. Oxygen should be continued 5 to 10 minutes after termination of anesthetic delivery
5. Place animal in sternal recumbency
6. The cuff should remain inflated during extubation
7. A stomach tube should be available to decompress the rumen in the event of bloat
I. The technician should monitor heart rate, pulse strength, muscle relaxation, pulse oximetry,
respiratory rate, mucous membranes, capillary refill time, and blood pressure
II. Small ruminant
A. Injectable anesthesia regimens and the use of isoflurane or sevoflurane for general anesthesia
are similar to those outlined for cattle
B. Intravenous catheter placement: 16- to 14-gauge, 3- to 51 2-inch catheters in adults; and
18- to 14-gauge, 2- to 3-inch catheters in young animals
C. Withhold feed for 24 hours and water for 12 hours in adults
1. Withhold feed for 2 to 4 hours in preruminant animals
D. Small ruminants should be intubated with a cuffed endotracheal tube to prevent aspiration
from regurgitation
E. Laryngospasm can be reduced by the use of topical anesthetic such as lidocaine. Oxygen
should be continued 5 to 10 minutes after termination of anesthetic delivery
F. The cuff should remain inflated during extubation
G. A stomach tube should be available to decompress the rumen in the event of bloat
 H. Eye position as a measurement of anesthetic depth is not as accurate in small ruminants as
in cattle
III. Swine
A. Some concerns when anesthetizing swine
1. Fewer accessible superficial veins and arteries
2. A higher incidence of malignant hyperthermia
a. Tracheal intubation is difficult in adult swine (Figure 26-6)

FIGURE 26-6 Small ruminant mouth speculum to use for intubation or examination of the oral cavity. (Courtesy Shirley Sandoval.)

b. Oral cavity is small

c. Larynx is long and mobile
d. Laryngeal spasm is common
e. Pharyngeal diverticulum
f. Use a cuffed endotracheal tube
3. Withhold food 8 to 12 hours; do not withhold water
B. Induction can be achieved using
1. Tiletamine-zolazepam or propofol
a. These can be used alone for short procedures
2. Ketamine can be used with xylazine or inhalants, such as sevoflurane or isoflurane
3. A mixture of guaifenesin (5% solution), ketamine (1 mg/mL), and xylazine
(1 mg/mL) can be used in adult swine
4. Isoflurane or sevoflurane by face mask
C. Eye reflexes and position are unreliable for monitoring swine
D. Heart rate, respiratory rate, muscle relaxation, and pulse strength (if possible) should be
monitored
E. As with ruminants, continue oxygen 5 to 10 minutes after inhalation and position the animal
in sternal recumbency as soon as possible
F. Unless there is evidence of regurgitation, extubate with the cuff deflated
1. Keep the patient away from other swine until well recovered
IV. South American camelids
 A. Injectable anesthesia regimens and the use of isoflurane or sevoflurane for general anesthesia
are similar to those outlined for cattle
B. Intravenous catheter placement: 16- to 14-gauge, 3- to 51 2-inch catheters in adults; and
18- to 16-gauge, 2- to 3-inch catheters in young animals
C. Withhold feed for 24 to 48 hours and water for 12 hours in adults
1. Withhold feed for 2 hours in young
D. Intubate as with small ruminants using a cuffed endotracheal tube
E. Monitoring is as with small ruminants
F. Keep nose lower than the pole to prevent aspiration of regurgitation
G. Maintain on oxygen 5 to 10 minutes after termination of anesthetic delivery
H. Place animal in sternal recumbency
I. The cuff should remain inflated during extubation

RUMINANT, SOUTH AMERICAN CAMELID, AND SWINE

SURGERY
Before any surgical procedure, it is imperative to ascertain the clostridial vaccination status of the patient (Table
26-2).

TABLE 26-2
Clostridial Diseases With Biologicals

System/Cause Signs Other comments

Clostridium chauvoei (Blackleg)

Cattle

Clostridial myositis Severe lameness; depression; anorexia; temperature of Death occurs in 12-36 hr
106 F (41 C); increased pulse of 100-120
beats/min; acute hot/painful edema that becomes
cold/painless with emphysema as disease progresses

Sheep and Goats

Clostridial myositis Clinical signs include lameness, high fever, anorexia, Young rams housed together, butt
depression, and death heads, and create wounds for the
organisms to enter
System/Cause Signs Other comments

Clostridium septicum and Clostridium sordellii (Malignant Edema)

Cattle

Gas gangrene Lesion with painful swelling, with or without Death occurs in 24-48 hr
emphysema, temperature of 106-107 F (41-
42 C), depressed, weak, muscle tremor, lame, or
stiff

Sheep

May occur after lambing, shearing, castration, or tail Organisms transmitted from soil to
docking; swelled head animals through open cuts,
wounds, surgical incisions, and
umbilicus

Clostridium novyi Type B (Black Disease)

Cattle

Infectious necrotic Initiated by damage to liver; causes severe depression, an

hepatitis initial fever followed by subnormal temperatures,
rumen atony, and abdominal pain - may last 1-
2 days; animals tend to separate from the herd

Sheep and Goats

Initiated by Causes severe depression and an initial fever followed by Rapid death usually at night; minimal
damage to the subnormal temperatures clinical signs observed
liver
System/Cause Signs Other comments

Clostridium haemolyticum (Bacillary Hemoglobinuria)

Cattle and Sheep

Initiated by Clinical signs include fever, rumen atony, anorexia, Death occurs in 12-96 hr.
damage to the abdominal pain, toxemia, arched posture, and dark-
liver red urine (red water)

Clostridium perfringens Type D (Pulpy Kidney)

Cattle

Peracute disease: animals found dead Affects calves 1-4 mo of age

Acute disease: animals exhibit bellowing, mania, Occurs in the summer/fall in
seizures, and death in 1-2 hr irrigated fields of endemic areas
Subacute disease: animals appear quiet and docile, Signs may last 2-3 days
show adipsia, and may appear blind Quick, complete recovery

Sheep

Lambs with peracute disease present with sudden death Adults may live up to 24 hr, lag
Lambs with acute disease (< 2 hr) present with behind, and show staggers,
depression, clonic seizures, diarrhea, opisthotonus, knuckling, and a rapid, shallow
and death respiration
Commonly caused by overeating
milk, milk replacer, or a high
carbohydrate diet in fast-growing
juvenile calves, lambs and kids
Avoid overfeeding and vaccinate
for C. perfringens type D, and
types C and D in breeding ewes
If an outbreak occurs in lambs,
an enterotoxemia antiserum may
also be administered
Can also affect goats
System/Cause Signs Other comments

Goats

Peracute disease presents with fever, abdominal pain, Death occurs in 4-36 hr
dysentery, and seizures Goats with acute disease may
Goats with acute disease present with abdominal recover in 2-4 days or die
pain and diarrhea

Enteric Disease in Piglets

Peracute and acute disease each show varying degrees of

hemorrhagic diarrhea and death within 2 days
Subacute disease produces diarrhea, which can last 7
days and produces a dehydrated piglet, resulting in
death in 5-7 days
Chronic infections result in diarrhea, with chronic ill
thrift, and sometimes death

Clostridium perfringens (Hemorrhagic Enterotoxemia)

Cattle

Gastrointestinal Includes diarrhea, acute abdominal pain, and nervous Mainly affects calves up to 10 days of
(GI) system signs age
May result in sudden death or a
slow recovery in 10-14 days

Sheep
System/Cause Signs Other comments

GI system Peracute form of the disease causes sudden death Affects lambs at 1-4 days of age
Acute form of the disease causes diarrhea, anorexia, Death occurs in 24 hr
and severe abdominal pain

Adult sheep Struck: sudden death

Clostridium tetani (Tetanus)

Cattle

Toxins affect central Bloat, prolapse of the third eyelid, muscle stiffness, muscle
nervous spasm, increased response to sound and tactile
system stimuli, and muscular rigidity

Sheep

Clinical signs include prolapse of the third eyelid, erect After shearing or tail docking
ears, muscle stiffness, muscle spasms, an increased Can give antitoxin when
response to sound and tactile stimuli, and muscular processing animals
rigidity (sawhorse stance), followed by seizures,
respiratory arrest, and death
I. Laparotomy (cattle)
A. A laparotomy for diagnostic purposes or for surgical intervention for a condition such as
LDA, RDA, cesarean section, or rumenotomy is routinely performed with the animal standing
in a chute or stocks using local anesthetic
B. The incision is made in the paralumbar fossa, and the area to be prepared includes a wide
margin surrounding the incision site
C. The hair is clipped, any gross debris is removed, and surgical preparation is performed over
the entire clipped area
D. The tail should be tied to the animals hind leg or attached by rope to her halter, to keep
her from swinging it into the incision
1. Never tie a bovines tail to a post or rail, because it can easily amputate its tail
E. Sutures should be removed 10 to 14 days after surgery
F. On occasion the surgeon may elect to perform a paramedian or ventral midline celiotomy for
an RDA or a cesarean section
1. Note the location of the abdominal vasculature before casting as they are less
noticeable once cast; the surgeon will want to avoid them
2. The cow is cast with ropes and placed in dorsal recumbency
II. Digit amputation (cattle)
A. The cow is placed in lateral recumbency with the affected claw up
B. The claw and interdigital space are thoroughly cleaned of manure and debris
C. The area is clipped from mid-metacarpus/metatarsus to the hoof and aseptically prepared in
a routine manner
D. Anesthesia is achieved with a ring block or intravenous regional infusion using rubber
tubing as a tourniquet distal to the carpus or hock
E. Obstetrical or Gigli wire is used to amputate the claw
F. The foot is bandaged for 2 to 3 weeks while the wound is granulating in (unless complicated
by infection); may need frequent bandage changing
III. Teat laceration repair (bovine and caprine)
A. This surgery may be performed with the animal in standing, lateral, or dorsal recumbency
B. A ring block is used on the affected teat, and complete surgical preparation is performed
1. Rubber tubing or Penrose drain used as a tourniquet will control bleeding and milk
leakage (see Web Fig. 26-7)
WEB FIGURE 26-7 Penrose drain, used for wound drainage, but also can be used for a tourniquet. (Courtesy Shirley Sandoval.)

2. A teat prosthesis may be inserted at the time of repair

C. Postoperatively, the insert will allow the affected teat to drain while the other quarters are
being milked
D. Hand milking should not be done because it may interfere with the suture line
E. Sutures are removed in approximately 10 to 14 days
F. Similar surgical technique is used on the doe
IV. Eye enucleation (bovine)
A. The cow will have to be restrained in a chute while a halter secures its head to one side
B. Regional anesthesia is done with a Peterson eye block or a four-point retrobulbar block
C. The eyelids maybe sutured closed, and then the area is clipped and prepared for surgery;
avoid the use of alcohol around the eyes
D. Preparation maybe complicated by necrotic and contaminated tissue
E. Postoperative care will include antibiotics and perhaps a wound spray on the surgical site
V. Castration
A. Bovine
1. Calves are usually castrated from 1 to 4 weeks of age
2. Current research has demonstrated the use of local anesthesia applied to either the
skin or spermatic cord (or both) for castrations decreases recovery time and does not
impede subsequent weight gain of feedlot calves, in contrast to lack of anesthesia.
Although the use of anesthesia/analgesia for routine castration of young animals is
gaining in popularity, it has yet to be considered standard of practice in a herd setting
3. For open castration, an incision is made in the scrotum (with a scalpel blade,
Newberry knife, or castration knife) (see Web Fig. 26-8) and an emasculator (see Web
Fig. 26-9) is used to sever and crush the spermatic cord
WEB FIGURE 26-8 Newberry knife, used to split the scrotum of calves for castration. (Courtesy Shirley Sandoval.)

WEB FIGURE 26-9 Emasculators. A, Modified White. B, Self-retaining Serra. (Courtesy Shirley Sandoval.)

4. An emasculatome is used for closed castration

a. This device crushes and severs the spermatic cord without incising the skin
of the scrotum (see Web Fig. 26-10)
WEB FIGURE 26-10 Burdizzo emasculatome, used for bloodless castration. (Courtesy Shirley Sandoval.)

5. Calves are sometimes castrated using an elastrator, or elastic band, around the
scrotum and testicles (see Web Fig. 26-11)
b. This procedure is preferably performed within the first few weeks of life;
however, it can be successfully performed in older animals

WEB FIGURE 26-11 Elastrator band applier, used to place a constricting rubber band when castrating or tail docking of young
lambs or castrating calves. (Courtesy of Shirley Sandoval.)

B. Small ruminants
 1. Lambs (if used for wool) are castrated within the first 1 to 2 weeks of life using an
elastrator, and are tail-docked at the same time, using the elastrator band, a
cauterizing tail docker, or a knife
2. Sometimes an open or closed method of castration is used, as described previously
for calves
3. Lambs destined for meat are usually only tail docked and are often not castrated
because they reach market weight before sexual maturity
4. Kids are castrated within the first 1 to 3 weeks of life using methods described
previously for lambs
5. Other procedures performed at this time include vaccination against clostridial
infection and injection of vitamin E and selenium (see Table 26-2).
C. Swine
1. Piglets are usually castrated at 1 to 2 weeks of age using an open technique
2. Other procedures performed before or at this time are iron dextran injection to
prevent anemia, tail docking to prevent cannibalism in confined housing, and clipping
of milk or needle teeth (canines and third incisors) to prevent injury to the sow
3. Frequently, inguinal hernias are discovered in the piglet at the time of castration
a. The skin of the inguinal area should be prepared with an antiseptic solution
before repair
b. Piglets should be placed in a clean, warm pen until fully recovered
D. South American camelids
1. Castration
2. Recommended to wait until after 2 years of age
3. May be performed standing or cushed; with sedation and local anesthesia
4. Tail should be wrapped and scrotum prepared with an antiseptic solution
5. The scrotum is incised and the spermatic cord is stripped
6. The cord is then transfixed, and the spermatic cord is severed
7. The scrotum is left open for drainage
VI. Dehorning
A. Calves: dehorning in cattle is done to prevent injury from fighting
1. It is preferable to disbud calves at 1 to 2 weeks of age using an electric dehorner
(Figure 26-7, E)
a. Caustic pastes should be avoided
FIGURE 26-7 Dehorning equipment used to remove, cauterize, or disbud horned animals. A, Hard-backed saw; B, Barnes
dehorners; C, tube dehorners; D, OB wire and handles; E, disbudding/dehorning irons. (Courtesy Shirley Sandoval.)
2. If the horn buds are 1 to 2 cm (12 to 1 inch), a tube dehorner or gouge-type
dehorner (Barnes) can be used (Figure 26-7, B and C)
B. Mature horns can be removed with a Keystone dehorner, a hardback saw, or a wire saw (see
Figure 26-7, A)
1. Local analgesia for dehorning can be achieved with a cornual nerve block or ring
block
2. Considerations are control of pain and hemorrhage and protection against fly strike
in the dehorn wound
C. Cosmetic dehorn of adult cattle
1. Difficult because there is a limited amount of skin to cover the wound
2. Area around each horn is clipped, aseptically prepared, and anesthetized as
described earlier
3. Horns are removed using a saw or wire and the surrounding skin is undermined to
provide skin flaps to cover the wound.
4. Sutures are placed to oppose skin as well as relieve tension along the incision line
5. Fly spray should be applied to the area surrounding the incision sites
6. Suture can be removed as early as 14 days
D. Kids
1. Goats should be dehorned using an electric dehorner as soon as the horn buds are
palpable
2. Goats are very susceptible to pain and can die of shock and fright, so analgesia is
often provided
 3. Use of cornual and infratrochlear nerve blocks (see discussion of anesthesia)
a. Be cautious of toxic dose in kids
(1) Dosage is q.s. (quantity required) lidocaine 0.5% to 1%
concentration to increase volume of anesthetic
4. Brain tissue is superficial in young goats and may be damaged if the iron is left on
too long
5. A bandage may be placed on the head but too tight. Other goats may try to consume
the bandage
E. Adult goats
1. Cornual and infratrochlear nerve blocks (see anesthesia), or general anesthesia
should be performed. Goats are easily stressed
2. OB wire or saw should be used; Barnes and Keystone dehorners should be avoided
(see Figure 26-7, D)
3. May open the frontal sinus, need to bandage and treat to prevent fly strike
4. Analgesics are recommended
VII. Prolapse repair
A. Rectal prolapse
1. Mucosal protrusion from the rectum, may be edematous, inflamed and/or necrotic
2. Determine and treat the cause of the prolapse
3. Prolapse repair
a. Purse string
(1) Epidural anesthesia
(2) Clean tissue, decrease swelling with hypoosmotic and replace
prolapse
(3) Purse-string suture placed perirectally to prevent prolapse, but
allow for defecation
b. Submucosal resection
(1) Necrotic surface tissue, but healthy underlying tissue
(2) Prepare as previously described
(3) Secure flexible tube into the rectal lumen using 90-degree cross
pins for stabilization
(4) Necrotic tissue is removed with two circumferential incisions
through the mucosal layer
(5) Suture opposing mucosal layers together
c. Amputation
(1) Prepare as for the submucosal resection
(2) Circumferential incision is made cranial to the necrotic tissue,
leaving the inner submucosa and mucosa intact
(3) Create a flap from the inner mucosa/submucosa by amputating a
few centimeters distal to the initial incision
(4) Suture opposing mucosal edges
4. In sheep, rectal prolapse is commonly related to short tail docking, but can also be
caused from straining or rectal pressure (feeding stock up hill, coughing,
overcrowding)
5. In swine, rectal prolapse is caused from straining to defecate
a. Rectal prolapse may be treated as listed earlier or with the use of a rectal
prolapse tube/ring.
b. The tube is placed in the rectum to the half-way point or notch and a rubber
band is placed in the notch to occlude the blood flow. The tube allows
 defecation while the amputation heals. Observe for complications, such as
occlusion of the tube with feces
B. Uterine prolapse
1. All species, more prevalent in bovine and ovine, less common in porcine
2. Occurs postpartum
3. Treatment: epidural anesthesia
4. Remove any placental remnants
5. Wash uterus and apply osmotic to decrease edema
6. Carefully replace the uterus using flat hand/fist not fingers
7. Reduce chance of perforation of the tissues
8. Ensure both horns are replaced to normal position and no invagination remains
9. Monitor patient for straining or reprolapse
10. For severely necrotic uterus, amputation may be necessary
C. Vaginal prolapse
1. Occurs primarily in pregnant females, but can occur in young open females
2. Multiparous, excessive pelvic fat, increased abdominal pressure
3. May be positional, only prolapses when she lies down
4. Breed predisposition in bovine and ovine
a. Brahman, Hereford
b. Romney
5. Treatment: epidural anaesthesia
6. Clean prolapse of debris
7. Empty urinary bladder if necessary
8. Decrease edema
a. Osmotic agents may be used to decrease edema
9. Replace vagina and suture vulvar lips
a. Buhner suture: cattle, swine
b. Purse-string or shoe lace pattern: small ruminants, South American
camelids
10. If close to parturition, monitor animal closely so suture may be removed
Please visit http://evolve.elsevier.com/Tighe/Brown/ to view additional figures, tables, and boxes that
accompany this chapter.

REVIEW QUESTIONS
1. Which of the following cattle breeds is considered a dairy animal?
a. Angus
b. Charolais
c. Hereford
d. Jersey

2. Which of the following goat breeds is used for meat production?

a. Alpine
b. Boer
c. Dutch Toggenburg
d. La Mancha

3. All of the following should be considered for hypodermic needle selection EXCEPT the:
 a. Size of the syringe
b. Viscosity of the substance being injected
c. Size of the animal
d. Route of administration

4. With respect to food-producing animals, why is it recommended to perform intramuscular injections

in the lateral cervical region?
a. The cervical muscles are easily discarded and not considered an economically favorable cut
b. Performing injections near the head will reduce the chances of the operator getting kicked
c. The cervical muscles are very large and provide a bigger area for intramuscular injections
d. There are no structures in the neck that can be damaged by an intramuscular injection

5. Which route is least likely for administration of large volumes of fluids in agricultural animals?
a. Intravenous
b. Intraperitoneal
c. Subcutaneous
d. Oral

6. Why is it important to follow the proper sampling technique to test for mastitis?
a. It markedly decreases the occurrence of cross contamination
b. There is no need to follow a specific sampling technique
c. It decreases the chances of the operator being injured by the cow
d. It eliminates the possibility of having a false-positive test

7. What is important to remember when giving intravenous calcium to treat hypocalcemia?

a. Administer slowly because the calcium is cardiotoxic and can cause cardiac arrest
b. Administer rapidly because the calcium is cardiotoxic and can cause cardiac arrest
c. Calcium should not be given intravenously because it is irritating to the vascular tissues
d. Calcium should be diluted in 5 L of sterile water before administration

8. Which of the following structures make it difficult to pass a urinary catheter in a bull?
a. Sigmoid flexure and urethral diverticulum
b. Urethral process and sigmoid flexure
c. Os penis and urethral process
d. Urethral diverticulum and os penis

9. Free gas bloat may be treated by:

a. Oral administration of antifroth surfactant
b. Increasing carbohydrates in the diet
c. Decreasing water consumption
d. Passing an orogastric tube to release the gas pressure

10. Bar magnets are administered orally to cattle to prevent which disease?
a. Listeria
b. Blue tongue
c. Hardware
 d. Lumpy jaw

11. Which of the following are zoonotic abortive diseases of large animals?
a. Blue tongue, vibriosis, rabies
b. Q-Fever, bangs, listeriosis
c. Leptospirosis, neosporasis, orf
d. Trichomoniasis, mucosal disease, chlamydiosis

12. Which of the following diseases may develop into a persistently infected animal?
a. Bovine viral diarrhea virus
b. Parainfluenza III
c. Blue tongue virus
d. Bovine respiratory syncytial virus

13. An insect vector is responsible for which of the following diseases?

a. Trichomoniasis
b. Listeriosis
c. Blue tongue
d. Anaplasmosis

14. Contagious foot rot in sheep is caused by:

a. Bacteria
b. Fungus
c. Protozoa
d. Virus

15. Large animals in lateral recumbency during general anesthesia should be positioned on a padded
surface with their:
a. Lower forelimb pulled back
b. Lower forelimb pulled forward
c. Upper forelimb pulled back
d. Upper forelimb pulled forward

16. Ring blocks maybe used for all of the following surgical procedures EXCEPT:
a. Claw amputation
b. Dehorning
c. Laparotomy
d. Teat surgery

17. Withholding food and water from ruminants before general anesthesia helps decrease or prevent:
a. Bloat
b. Regurgitation
c. Ventilation compromise
d. All of the above

18. Which instrument is used for bloodless castration and tail docking in lambs?
a. Branding iron
 b. Elastrator bands
c. Emasculator
d. Newberry knife

19. The anesthetic protocol for replacement of rectal, uterine, or vaginal prolapse is:
a. Inverted L
b. Ring block
c. Line block
d. Epidural

20. Black disease is caused by which type of bacteria?

a. Cl. chauvoei
b. Cl. novyi
c. Cl. sordellii
d. Cl. haemolyticum

CHAPTER 27

Emergency Medicine
TRIAGE
I. Definitions
A. A veterinary emergency can be described as any situation that arises suddenly and
unexpectedly, resulting in an immediate need for action
B. Triage means to sort and is the initial assessment of the emergency patient and
prioritization of the patients medical needs. The goal of triage is to ensure that the most
serious cases are assessed first and the most life-threatening conditions are treated first
1. Initial triage often occurs over the phone when the owner calls the clinic. It is
important that technicians have strong communication skills and are proficient in
veterinary first aid. The information obtained from this call allows the veterinary
technician to better prepare for the arrival of the emergent patient
2. Hospital triage is performed immediately on presentation and should take less than
5 minutes. Triage consists of the primary survey and a brief medical history
a. If a patients condition is critical, the primary survey should be
performed by a veterinarian with the assistance of a veterinary technician
b. The primary survey should be performed in a systematic manner
c. The mnemonic device ABCD or variations of this mnemonic are commonly
used to guide the primary survey
(1) Airway
(2) Breathing
(3) Circulation
(4) Disability
3. Triage is the evaluation of the four different categories of patient needs based on an
acuity scale for major organ systems (cardiovascular, respiratory, neurological, and
renal systems) and simultaneously obtaining a capsule history
a. Acquiring a brief medical history is also an important step in triaging the
patient
(1) Acquiring the history can be the most difficult step
(2) Conversation should be guided by the technician and limited to
salient points only, avoiding irrelevant details
(3) The history should include the primary complaint, duration of the
problem, and any current drug therapy or chronic medical
conditions
(4) After triage a triage acuity scale is used to prioritize the
appropriate care for the patient
(5) The patient is categorized as stable or unstable, allowing
appropriate prioritization of care
4. Many different triage acuity scales are used in veterinary medicine. Some scales have
three levels and some have four or five levels. No matter which scale is used it should
be organized, and everyone in the hospital should use the same scale
a. A resuscitative/nonstable patient should receive care immediately for life-
threatening conditions
(1) A case example of this would be a patient in cardiac arrest or
respiratory distress
b. An emergent patient should receive care or be reevaluated within 5 to 15
minutes.
(1) A case example of this would be a patient with a serious laceration
or a fracture
c. A patient with an urgent condition should receive care or be reevaluated
within 15 to 45 minutes
(1) A case example of this would be a patient with nonhemorrhagic
vomiting or diarrhea
d. A stable patient is not exhibiting a life-threatening condition. These patients
should receive care or be reevaluated within 1 to 2 hours
(1) A case example of this would be a patient with a minor laceration
or an abscess
e. An unstable or an emergent patient is in a life-threatening condition and
requires quick judgment and prompt treatment
5. Good telephone triage questions include:
a. What are the breed, age, and sex of the animal?
b. Has any known trauma occurred?
c. Is the animal conscious or unconscious? Is the animal responding normally
to you?
d. Is the animal having any respiratory difficulty? (Increased rate, depth,
effort)
e. Is there any bleeding or obvious fractures?
f. Is the animal able to walk?
g. Has the animal had any vomiting or diarrhea?
h. Has the animal ingested anything other than its normal food or treats?
(1) If yes, have the owner bring the container/box with them to the
clinic
 i. Does the animal have any ongoing or chronic medical conditions?

THE PRIMARY SURVEY

Used to classify the patient on the triage acuity scale and to identify what treatment the patient should receive.

Respiratory System
I. Airway: determine patency of airway
A. Normal (patent airway and clear breath sounds)
B. Upper airway noise (stridor/stertor)
C. Distress with inspiration associated with stridor
II. Breathing: assess respiratory rate, effort, and depth
A. Assess respiratory rate
1. Normal: cat, 24 to 42 respirations per minute; dog, 10 to 30 respirations per minute
2. Tachypnea: increased respiratory rate
3. Apnea: no respirations
4. Agonal breath: last gasping breath
5. Cheyne-Stokes: tachypnea interspersed with apnea
B. Assess respiratory effort: hintmimicking the patients breathing pattern makes it
easier to determine if there is labored inspiration, expiration, or both
1. Normal: there should be no effort
2. Dyspnea
a. Labored inspiration
b. Labored expiration
c. Labored inspiration and expiration
3. Paradoxical respiration: chest wall and abdominal wall do not move synchronously
C. Postural adaptations of dyspnea
1. Normal: patient should not be posturing to breathe
2. Orthopnea
a. Stand rather than sit
b. Abduct elbows
3. Abdominal movement
4. Extended neck, open mouth, head lifted
D. Depth
1. Deep
2. Shallow

Cardiovascular System
I. Circulation
A. Mucous membrane color
1. Pink: normal
2. Muddy or gray: poor perfusion
3. Pale or white: anemia or poor perfusion
4. Brick red (hyperemic): septic shock (not to be confused with severe gingivitis)
(Figure 27-1)
FIGURE 27-1 Hyperemic (bright red) mucous membranes.
5. Dark blue (cyanosis): hypoxia
6. Yellow (jaundice): hepatic dysfunction, hemolysis, or biliary obstruction
7. Brown: methemoglobinemia (most commonly seen with acetaminophen toxicity)
B. Capillary refill time (CRT)
1. Normal: 1 to 2 seconds
2. Prolonged: greater than 2 seconds; indicates poor perfusion
3. Rapid: less than 1 second; indicates hyperdynamic state or hemoconcentration
C. Normal pulse rate
1. Dog: 70 to 160 beats per minute
a. Less than 70 beats per minute: bradycardia
b. Greater than 160 beats per minute: tachycardia
2. Cat: 150 to 210 beats per minute
a. Less than 150 beats per minute: bradycardia
b. Greater than 210 beats per minute: tachycardia
3. Pulse deficit occurs when the pulse rate is less than the heart rate
D. Pulse quality
1. Normal: strong and synchronous with heart rate
2. Weak: indicates poor perfusion
3. Snappy: anemia (tall and thin pulse quality)
4. Bounding: sepsis, hyperdynamic state

Central Nervous System

The following should be assessed on triage. Their severity will determine the stability of the patient.
I. Disability (assesses the patients level of consciousness and ability to move and feel pain)
A. Level of consciousness
1. Alert
 2. Depressed
3. Quiet, unwilling to perform normally; responds to environmental stimuli
4. Delirium/dementia: responds abnormally to environmental stimuli
5. Stuporous: unresponsive to environmental stimuli; responds to painful stimuli
6. Comatose: no response to environmental and painful stimuli
B. Gait
1. Ataxia/weakness
2. Loss of motor function
C. Muscular twitching
1. Hypocalcemia (i.e., eclampsia)
2. Pyrethrin toxicity
D. Head trauma
E. Nystagmus: rapid eye movement
F. Head tilt

Life-Threatening Wounds
I. External assessment
A. Bleeding
B. Lacerations
C. Punctures
D. Contusions
E. Open fractures
F. Crepitus
G. Other deformities (i.e., dislocations)
H. Pain
II. Wounds to upper airway
A. Open or penetrating abdominal wounds
B. Wounds affecting major blood vessels

CARDIOPULMONARY CEREBRAL RESUSCITATION

CPCR can be performed only by a team, and therefore the first step should always be to alert the veterinarian
and other technicians of an emergency situation involving cardiac or respiratory arrest.
I. A common memory cue for CPCR is ABCD

A Airway C Cardiac/circulation

B Breathing D Drugs

A. Airway
1. Establish and secure a patent airway
a. Endotracheal intubation
b. Tracheostomy if unable to intubate
c. Abdominal compression if choking
B. Breathing
1. Resuscitation/Ambu bag connected to oxygen supply or anesthesia machine, 8 to 12
breaths per minute with a tidal volume of 10 mL/kg and an inspiratory time of 1
second (Figures 27-2, A and B)
a. Maximum of 20 cm of H O pressure for dog (if using anesthesia machine
2

manometer)
b. Maximum of 15 cm of H O pressure for cat (if using anesthesia machine
2

manometer)
FIGURE 27-2 A. Cat receiving ventilation with Ambu bag during cardiopulmonary cerebral resuscitation (CPCR). B, Cat is
intubated and receiving ventilation via Ambu bag during CPCR. Doppler probe is placed on the eye to evaluate efficacy of
chest compressions.
2. Mouth to endotracheal tube if there is no oxygen supply
3. Mouth to muzzle with a rate of 2 breaths per 30 compressions is recommended
C. Cardiac and circulation
1. Continuous electrocardiographic monitoring
2. Chest compressions (external cardiac massage) should start immediately
a. Animal should be in right lateral recumbency; exceptions are cats and large,
round, barrel-chested dogs
(1) Cats should be in dorsal recumbency
(2) Large, round, barrel-chested dogs should can be in right lateral or
dorsal recumbency with hands directly over the heart (use the point
of the elbow to locate the heart)
b. Count four to six rib spaces and place hands on the widest part of the chest
or use patients point of the elbow to locate the heart
c. Using two hands in large dogs, press down on the chest with heel of the
lower hand
(1) For cats and small dogs (< 10 kg), squeezing the chest (directly
over the heart) between the index finger and thumb is sufficient
(Figure 27-3)

FIGURE 27-3 Cat receiving one-handed chest compressions with right hand (between thumb and fingers) while left hand
provides support for the compressions.
(2) Compress the chest at a rate of 100 to 120 per minute
(3) Compress the chest half to one-third the width of the chest and
allow chest to return to normal position between compressions
 (4) A ventilation rate of 1 ventilation to 1 chest compression 10 breaths
per minute is recommended with a tidal volume of 10 mL/kg and
an inspiratory time of 1 second
3. Volume replacement
a. Isotonic crystalloids
b. Blood components
c. Synthetic colloids
D. Drugs
1. Intravenous access
2. Intravenous drugs
a. Atropine sulfate: increases heart rate
b. Epinephrine: increases heart rate and force of contraction
c. Lidocaine: used in occasional arrest situations as an antiarrhythmic
d. Sodium bicarbonate: used in occasional arrest situations to correct metabolic
acidosis
3. Intratracheal drugs
a. When venous access cannot be obtained immediately, the following drugs
should be administered via endotracheal tube at twice the intravenous dose
(1) Ideally the drugs should be administered as close to the carina of
the trachea (site of tracheal bifurcation)
(a) Using a syringe with a red rubber feeding tube or
polypropylene urinary catheter attached, slide the tube or
catheter down the endotracheal tube just proximal to the
thoracic inlet and inject the medication
(b) Inject air into the endotracheal tube
(c) Alternatively, using just a syringe, inject the drug down the
tube, and forcefully blow air through the endotracheal tube
(2) Epinephrine
(3) Atropine
(4) Lidocaine
4. Intracardiac drugs
a. To be used only as a last resort: this route is not recommended
b. Use lower dose of drug, place needle in the area where the heart would be
anatomically, aspirate and check for blood, and administer drug
c. Epinephrine
d. Isoproterenol: for bradycardia or heart block
II. Hints for successful CPCR
A. An arrest station or special area to conduct CPCR is ideal; however, many practices have
crash carts so that all necessary supplies are readily available
B. Necessary supplies include:
1. Oxygen
a. S-Bag, Ambu bag, or anesthesia machine
2. Crash cart or emergency kit (Figure 27-4)
a. Endotracheal tubes
b. Laryngoscope
c. Intravenous catheters, fluids, administration sets, tape, syringes, needles,
tourniquet
(1) Venous cutdown supplies: scalpel blades, catheter introducers,
suture material
 d. Drugs; do not predraw drugs into syringes. Many drugs are sensitive to
light and plastic. Have syringes and drug labels available in arrest drugs
drawer
e. Chart of dose rates for all drugs in the kit
f. Clippers
g. Electrocardiographic monitor
h. Pulse oximeter
i. Capnograph
j. Defibrillator
k. Suction and suction tips

FIGURE 27-4 Emergency crash cart completely labeled for quick recovery of medications and equipment. Note the
defibrillator on top of the cart.

MONITORING STATUS OF EMERGENCY PATIENTS

Frequent and perceptive evaluation of physical examination parameters is the fundamental basis of emergency
and critical care monitoring. The four major organ systems should be closely monitored at all times. The status
of the emergent patient can rapidly change; therefore it is essential that the emergency technician be capable of
noticing slight changes in the patients physical parameters. If changes occur in the patients status, the
veterinarian should be notified immediately. The following sections will not discuss normal parameters; only
abnormal parameters will be addressed.

Respiratory System
Patients in respiratory distress are often very unstable; minimizing stress to the animal is extremely important.
Physical examination, diagnostics, and treatments are performed in stages to allow the patient to rest and
breathe in an oxygen-enriched environment. It may be necessary to rule out primary heart disease before
sedation in some cases.
Patient monitoring should include respiratory status, cardiovascular status, renal status, and temperature
(Tables 27-1 and 27-2).

TABLE 27-1
Oxygen Delivery Methods for Respiratory Emergencies

Oxygen Delivery
Flow Rate Advantage Disadvantage
Method

Endotrachael tube Rebreathing Protects airway Patient must be sedated or anesthetized

40 mL/kg/min Efficient or unconscious
Nonrebreathing Hands-on patient
200 mL/kg/min monitoring
Some skill
required
Can be used with
ventilator

Flow-by oxygen 2-3 L/min Easy Labor intensive

Hands-on patient High flow rates
monitoring

Nasal catheter 100-150 mL/kg/min Some skill required Not useful in cats
Hands-on patient Needs bubbler
monitoring
Well tolerated
Unilateral or
bilateral
Oxygen Delivery
Flow Rate Advantage Disadvantage
Method

Oxygen mask 2-5 L/min Easy Some patients resist

Labor intensive
High flow rate

Oxygen hood 2-5 L/min Well tolerated Humidity can build up

Hands-on patient
monitoring

Oxygen cage 2-5 L/min Well tolerated Expensive

Humidity or temperature build-up
Small dogs and cats only
Cannot touch patient
 TABLE 27-2
Respiratory Emergencies

Clinical Signs Treatment

Collapsing Trachea (Most Commonly Seen in Small-Breed Dogs)

Loud goose honk cough with expiration, postural Supply oxygen, calm with sedation when necessary (rule out
indications of dyspnea, hyperthermia primary heart disease before sedation), surgical
intervention

Laryngeal Paralysis (Most Commonly Seen in Large-Breed Dogs)

Noisy breathing, distress with inspiration, postural Supply oxygen, calm with sedation, endotracheal intubation,
adaptations of dyspnea surgical intervention, tracheostomy

Foreign Body

Noisy breathing, distress with inspiration, acute onset of Supply oxygen, remove obstruction
gagging with severe respiratory distress, postural
adaptations of dyspnea, hyperthermia

Soft Tissue Swelling: Allergic Reaction

Facial swelling, generalized urticaria (hives), noisy Dexamethasone sodium phosphate (antiinflammatory
breathing, distress with inspiration, postural agent), diphenhydramine HCl (inhibits histamine
indications of dyspnea release)

Soft Tissue Swelling: Tumor

Clinical Signs Treatment

Noisy breathing, distress with inspiration, postural Supply oxygen, calm with sedation, intubation,
adaptations of dyspnea, hyperthermia tracheostomy, surgical intervention

Brachycephalic Occlusive Syndrome (Elongated Soft Palate, Stenotic Nares, Hypoplastic Trachea,
Everted Laryngeal Saccule)

Upper airway stertor, distress with inspiration, postural Supply oxygen, calm with sedation, intubation,
adaptations of dyspnea, hyperthermia surgical intervention, tracheostomy

Small Airway Disease: Feline Asthma

Dyspnea (prolonged expiration), postural indications of Supply oxygen, bronchodilator, corticosteroids

dyspnea, expiratory wheeze

Pneumonia

Tachypnea, dyspnea (inspiration and expiration), postural Supply oxygen (100% initially); 40% oxygen is suggested for
indications of dyspnea, pyrexia, cyanosis, long-term therapy (100% oxygen for > 12 hr can
lung auscultation (harsh sounds), crackles result in pulmonary oxygen toxicity), appropriate
antibiotic therapy, nebulizer, coupage, positive
pressure ventilation

Contusions

Tachypnea, dyspnea, postural indications of dyspnea, Supply oxygen, fluid therapy, positive-pressure
evidence of recent trauma, shock, cyanosis, ventilation
hemoptysis, lung auscultation (harsh lung
Clinical Signs Treatment

sounds), crackles

Pulmonary Edema

Tachypnea, dyspnea, postural adaptations of dyspnea, Supply oxygen, diuretics, positive-pressure ventilation
cyanosis, burns in mouth (suggestive of
electric shock), ongoing fluid therapy (suggestive of
fluid overload), harsh lung sounds, crackles,
heart murmur

Pulmonary Neoplasia

Tachypnea, dyspnea, cyanosis, harsh lung sounds, Supply oxygen, positive pressure ventilation
crackles

Pneumothorax

Tachypnea, dyspnea, (rapid and short inspirations and Supply oxygen, evacuate air (thoracocentesis), chest tube
expirations), cyanosis, postural indications of (placed when negative pressure is not achieved or when
dyspnea, decreased or muffled lung sounds dorsally, it is necessary to tap chest repeatedly)
evidence of recent trauma

Pleural Effusion (Hemothorax, Pyothorax, Chylothorax, and Serous Effusion)

Clinical Signs Treatment

Tachypnea, dyspnea, postural adaptations of dyspnea, Supply oxygen, evacuate fluid (chest tap), chest tube
cyanosis, decreased muffled lung sounds
ventrally

Diaphragmatic Rupture

Tachypnea, dyspnea (paradoxical abdominal movement), Supply oxygen, surgical correction

postural adaptations of dyspnea, cyanosis,
evidence of trauma, auscultation of borborygmus
in thorax, decreased/muffled lung sounds, cardiac
displacement
 I. Postural adaptations of dyspnea
A. Orthopnea
1. Patient would rather stand than sit or lie sternally
2. Abducted elbows
II. Respiratory rate
A. Tachypnea: increased respiratory rate
B. Apnea: no respiratory rate
C. Cheyne-Stokes: tachypnea interspersed with apnea
III. Respiratory effort
A. Labored inspiration
1. Upper airway disorders
a. Collapsing trachea (Figure 27-5)

FIGURE 27-5 Ventral dorsal radiograph of dog with hole in its trachea. Note free air between body wall and skin.
b. Laryngeal paralysis
c. Foreign body
d. Soft tissue swelling
e. Brachycephalic occlusive syndrome
B. Labored expiration
1. Feline asthma
C. Labored inspiration and expiration
1. Parenchymal disorders
a. Pneumonia
b. Contusions
c. Pulmonary edema
d. Neoplasia
D. Short inspiration and expiration
1. Pneumothorax
 2. Pleural effusion
3. Diaphragmatic rupture
E. Paradoxical respiration: chest wall and abdominal wall do not move synchronously
IV. Auscultation of lungs
A. Dull lung sounds ventrally
1. Indicates a pneumothorax
B. Dull lung sounds dorsally
1. Indicates a pleural effusion
C. Harsh lung sounds
1. Indicates parenchymal disorders
a. Pneumonia
b. Pulmonary contusions
c. Pulmonary edema
d. Neoplasia
D. Crackles
1. Parenchymal disorders
a. Cardiogenic
(1) Right-side heart failure
b. Noncardiogenic
(1) Fluid overload
(2) Strangulation
(3) Electrocution
V. Oxygenation status
A. Arterial blood gas is more invasive and more accurate
1. It requires placement of an arterial line (most commonly placed in the metatarsal
artery) or obtaining sample via a blood gas syringe
2. PaO (partial pressure of oxygen in the arterial blood) less than 80 mm Hg: may
2

require oxygen supplementation or mechanical ventilation

3. PaCO (partial pressure of carbon dioxide in the arterial blood) greater than 45 mm
2

Hg: may require mechanical ventilation

B. SaO (percentage of available hemoglobin that is saturated with oxygen) reading
2

1. Less invasive and potentially less accurate

2. Readings can be falsely high or low because of equipment failure, heart arrhythmias,
human error, motion, hypothermia, and patients pigmentation
3. Requires a pulse oximeter
4. Less than 92% indicates hypoxia
C. Capnography (monitors the partial pressure of carbon dioxide/end-tidal carbon dioxide)
1. Noninvasive
2. Requires capnograph
3. Hypercarbia can indicate decreased ventilation
4. Hypocarbia can indicate hyperventilation, pain, or hypoxia

Cardiovascular System
Emergencies affecting the cardiovascular system result from failure of the heart to pump blood throughout the
body or from an inappropriately low blood volume. These conditions frequently cause shock and result in poor
tissue perfusion. The mainstay of therapy for hypovolemic, distributive and obstructive septic, neurogenic, and
anaphylactic shock is aggressive volume replacement. In contrast, volume replacement can be fatal in the
patient with heart failure or cardiogenic shock; therefore it is essential to differentiate between these conditions
(Table 27-3).
 TABLE 27-3
Cardiovascular Emergencies

Clinical Signs Treatment

Hypovolemic Shock

Pale, gray, or muddy mucous membrane color; prolonged Shock fluid therapy (isotonic crystalloid, hypertonic
capillary refill time; rapid pulse rate, weak pulse quality; crystalloids, blood products, artificial colloid),
evidence of acute blood loss; evidence of fluid loss oxygen supplementation
(vomiting, diarrhea); evidence of fluid sequestration

Septic, Neurogenic, or Anaphylactic Shock

Brick red mucous membrane color, hyperdynamic, rapid Shock fluid therapy, blood culture (for septic
capillary refill time (< 1 second), tachycardia, bounding shock), antibiotics for septic shock,
pulse quality, hyperthermia, hypoglycemia corticosteroids for anaphylactic shock,
diphenhydramine for anaphylactic shock

Cardiogenic Shock: Congestive Heart Failure and Pericardial Tamponade

Pale or muddy mucous membrane color, prolonged capillary Congestive heart failure: oxygen supplementation,
refill time, rapid pulse rate, weak pulse quality, diuretics, inotropes, vasodilators, fluid therapy
tachypnea/dyspnea, postural indications of dyspnea, (very conservative, minimize stress levels)
cyanosis, evidence of trauma Cardiac tamponade: oxygen supplementation,
pericardiocentesis, fluid therapy (very
conservative, minimize stress levels)
I. Hypovolemic shock is poor tissue perfusion as a result of low blood volume
A. Frequently as a result of trauma
1. Internal hemorrhage
2. External hemorrhage
B. Severe dehydration ( 12%)
C. Third spacing of fluids
II. Distributive shock is poor tissue perfusion as a result of a maldistribution of blood flow. There are
numerous types of distributive shock
 A. Septic shock is caused by the presence of toxins in the blood or other tissues
B. Anaphylactic shock is caused by a hypersensitivity to an allergen
C. Neurogenic shock is caused by central nervous system damage
III. Obstructive shock is poor tissue perfusion as a result of a physical blockage not a primary heart
problem. An example of obstructive shock is a saddle thrombus or caval syndrome in heartworm-
positive patients
IV. Cardiogenic shock is poor tissue perfusion as a result of decreased forward blood flow from the
heart. Examples of cardiogenic shock include congestive heart failure or a severe cardiac arrhythmia
V. Monitoring devices, such as those for direct and indirect blood pressure, are necessary; however,
physical examination parameters are most important
A. Patient monitoring should include respiratory status, cardiovascular status, neurological
status, renal status, and temperature. Serial evaluations of an emergency blood screen are an
integral part of patient monitoring
B. Mucous membrane color
C. Capillary refill time
D. Pulse rate
E. Pulse quality
F. Blood pressure reading
1. Direct arterial pressure readings
2. Indirect pressure readings by
a. Oscillometric pressure monitor
b. Doppler blood flow monitor
G. Electrocardiography

Central Nervous System

Emergencies of the central nervous system may affect the brain and/or the spinal cord. It is important to rule
out hypoglycemia as a cause of seizures in patients presenting with continuous seizure activity. Behavior,
pupillary reflexes, pupil size, and eye movement are used to evaluate the brain. The spinal cord is assessed by
noting conscious proprioception, voluntary motor function, and superficial and deep pain (Table 27-4).

TABLE 27-4
Central Nervous System Emergencies

Clinical Signs Monitoring Treatment

Epilepsy

Hyperthermia, hyperdynamic state, Respiratory status (potential for Diazepam (good anticonvulsant
nystagmus/strabismus, aspiration during seizure); activity, must give to effect),
pupillary changes (miosis, cardiovascular status; neurological phenobarbital, pentobarbital
mydriasis, anisocoria) status (mental status: alert and (heavy anesthesia)
responsive, depressed, stupor,
coma, and pupillary light
response); renal status, body
Clinical Signs Monitoring Treatment

temperature

Head Trauma

Depression, stupor, coma, Respiratory status (trauma to the brain Corticosteroids, mannitol (osmotic
seizures, pupillary stem can cause altered ventilatory agent, can decrease intracranial
changes (miosis, mydriasis, status, important to keep carbon pressure through its osmotic
anisocoria), dioxide levels normal to low, effects), elevate head (place
nystagmus/strabismus, increased carbon dioxide will patient on flat board and elevate
blood in aural canal, cause increased intracranial board to approximately 30
hyphema, scleral pressure), cardiovascular status, degrees in attempt to decrease
hemorrhage, skull/facial neurological status, renal status intracranial pressure),
fractures ventilation (to decrease
carbon dioxide levels)

Acute Paresis and Paralysis

Loss of conscious proprioception, loss Respiratory status (patients with Conservative (commonly used when
of voluntary motor function, loss tetraparesis can experience loss of voluntary motor function is still
of superficial pain, loss of deep function to intercostal muscles), present), corticosteroids, strict
pain cardiovascular status, neurological cage rest, surgical intervention
status (conscious proprioception, (myelogram, laminectomy)
voluntary motor activity,
superficial pain, deep pain), renal
status (upper motor neuron:
hypertonic sphincter), (lower
motor neuron: bladder hypotonia)
 The causes of seizures include congenital and hereditary factors such as portosystemic shunt; inflammatory
disease processes; viral, bacterial, fungal, protozoal, or rickettsial organisms; metabolic or nutritional
deficiencies; trauma; a central vascular system breakdown; neoplasia; epilepsy; and toxicity.
I. Level of consciousness
A. Alert: normal
B. Depressed: quiet, unwilling to perform normally; responds to environmental stimuli
C. Delirium/dementia: responds abnormally to environmental stimuli
D. Stuporous: unresponsive to environmental stimuli; responds to painful stimuli
E. Comatose: no response to environmental and painful stimuli
II. Pupillary reflexes
A. Blink
B. Menace
C. Pupillary light response
1. Direct
2. Consensual
III. Pupil size
A. Miosis: pinpoint
B. Anisocoria: asymmetrical or unequal
C. Mydriasis: dilated
IV. Eye movement and position
A. Nystagmus
1. Horizontal eye movement
2. Vertical eye movement
B. Strabismus: abnormal eye position
V. Evaluate spinal cord compression by
A. Conscious proprioception
B. Voluntary motor function
C. Superficial pain
D. Deep pain

Renal System
The causes of renal system emergencies include acute and chronic renal failure, urethral obstructions, ruptured
ureter/bladder, and urethral tears. Patients with renal disease should be monitored by measuring urine
production, serum, creatinine, blood urea nitrogen, electrolytes (sodium, potassium, phosphorus, calcium), and
acid-base parameters on a pretreatment basis and throughout the patients treatment. Patient monitoring
should include respiratory status, cardiovascular status, neurological status, temperature, and serial emergency
blood screen readings (Table 27-5).

TABLE 27-5
Renal System Emergencies

Clinical Signs Treatment

Acute Renal Failure

Clinical Signs Treatment

Vomiting, diarrhea, dehydration, evidence of Pretreatment, emergency blood screen and creatinine and
exposure to toxins (e.g., ethylene glycol or phosphorus, fluid therapy (isotonic crystalloid solutions,
gentamicin) measure urine output, diuretics after rehydration),
peritoneal dialysis, gastrointestinal protectants

Chronic End-Stage Renal Failure

Weight loss, vomiting, anorexia, dehydration, anemia, Fluid therapy, electrolyte replacement (e.g., potassium),
lethargy blood transfusion, measure urine output

Feline Urethral Obstruction

Dysuria, hematuria, vomiting, vocalizing, painful Fluid therapy, electrocardiogram, treat arrhythmias with
abdomen, distended bladder on abdominal calcium gluconate, emergency blood screen, treat
palpation, hyperkalemia, hypocalcemia hyperkalemia because it can cause life-threatening
arrhythmias

Ureter and Bladder Rupture

Vomiting, diarrhea, hematuria, evidence of Radiographs, urinary catheter, excretory urogram,

trauma, abdominal effusion, red blood retrograde urethrography/cystography, surgical
cells in urine, abdominal pain, hypovolemic intervention, abdominocentesis
shock, decreased urine output

Urethral Tears

Vomiting, dysuria/hematuria, anuria, Urinary catheter, surgical intervention,

Clinical Signs Treatment

abdominal effusion, subcutaneous edema of abdominocentesis

hind limbs and ventral
abdomen hypovolemic shock,
hyperkalemia
 I. Urination
A. Monitor urination
B. Measure urine output
1. Indwelling urinary catheter with closed collection system
2. Normal values of urine output should be 1 to 2 mL/kg/hr
3. Input (fluid given) should equal output (fluid lost)
C. Central venous pressure: evaluates ability of the right ventricle to handle fluid therapy
1. An early indicator of fluid overload
2. Used when aggressive fluid therapy is indicated to treat renal failure or shock
II. Temperature
A. Hypothermia because of poor perfusion, anesthesia, exposure to cold
B. Hyperthermia because of infection, sepsis, heat prostration, malignant hyperthermia,
seizures, upper airway obstruction
III. Fluid losses should be assessed and recorded
A. Vomiting
B. Diarrhea
C. Blood loss
D. Effusions
E. Edema
F. Respiratory losses: excessive panting
IV. Emergency blood screen
A. Packed cell volume and total solids
B. Blood urea nitrogen and glucose analysis
C. Electrolyte analysis
1. Sodium
2. Potassium
3. Chloride
4. Calcium
5. Magnesium
D. Acid-base analysis
1. pH
2. PO2

3. PCO 2

4. HCO 3

ENDOCRINE AND METABOLIC EMERGENCIES

The treatment for a patient with an endocrine or metabolic emergency includes correcting dehydration,
electrolyte abnormalities, and metabolic abnormalities and providing appropriate drug therapy. Metabolic
disorders are always associated with a primary disease process.
Patient monitoring should include respiratory status, cardiovascular status, renal status, temperature, and
serial emergency blood screen analysis (Table 27-6).

TABLE 27-6
Endocrine and Metabolic Emergencies
Clinical Signs Treatment

Addisonian Crisis (Hypoadrenocorticism)

Clinical Signs Treatment

Hyponatremia, hyperkalemia (causing bradycardia), Fluid therapy: normal saline, glucocorticoid (dexamethasone most
hypovolemic shock, hypoglycemia, commonly used) will not interfere with adrenocorticotropic
hypercalcemia, vomiting, diarrhea, hormone stimulation test; correct acidosis (if severe, give
polyuria/polydipsia (PU/PD) sodium bicarbonate, supply oxygen)

Diabetic Ketoacidosis

PU/PD, vomiting, diarrhea, dehydration, Intravenous fluid therapy, insulin therapy, KCl replacement,
hypovolemic shock, hyperglycemia, glucosuria, phosphorus replacement
ketonuria, acidemia, tachypnea

Hyperglycemia

Vary depending on underlying disease process When diabetes is suspected, insulin therapy will be initiated

Hypoglycemia

Depressed, weakness, ataxia, stupor, blindness, Supplement with dextrose; a dextrose bolus must be diluted 1:4
seizure activity, coma with a crystalloid to prevent phlebitis

Hypercalcemia

Vary depending on cause of hypercalcemia Hypercalcemia is a medical emergency because of its effects on the
kidney; fluid therapy with 0.9% NaCl for rehydration and
increased calcium excretion; find underlying cause of
increased calcium
Clinical Signs Treatment

Hypocalcemia

Increased neuromuscular excitability (muscular Calcium supplementation, must be given slowly with continuous
twitching), generalized muscle tremors, electrocardiogram (ECG) monitoring; if arrhythmias or
seizures, hyperthermia bradycardia occur, calcium administration should be
discontinued

Hypernatremia

Dehydration, neurological signs Slowly correct dehydration and gradually lower sodium levels

Hyponatremia

Protracted vomiting and diarrhea, lethargy, coma Electrolyte replacement, correction of dehydration

Hyperkalemia

ECG: increased amplitude of T wave with decreased Restore potassium balance; fluid therapy, administration of
amplitude of R wave and prolonged PR intravenous regular insulin followed by dextrose
interval, then bradycardia with widening of administration is used to lower potassium levels; ongoing
QRS complex are eventually seen; cardiac fluid therapy with dextrose supplementation; administer
arrest calcium gluconate to protect myocardium and reverse
arrhythmias

Hypokalemia
Clinical Signs Treatment

Severe muscle weakness, ventroflexion of neck, Potassium supplementation via intravenous fluid administration;
stilted forelimb gait if giving shock bolus of fluid, do not use fluids that have been
supplemented with potassium
 GASTROINTESTINAL EMERGENCIES
Patient monitoring should include respiratory status, cardiovascular status, renal status, and serial emergency
blood screen readings. For gastric dilation, serial measurement of abdominal girth may be performed. A patient
with severe vomiting and diarrhea can be classified as emergent because of the cardiovascular effects of fluid
loss (Table 27-7).

TABLE 27-7
Gastrointestinal Emergencies

Clinical Signs Treatment

Gastric Dilation and/or Volvulus

Abdominal distention; nonproductive retching; pale, muddy, or Fluid therapy (rapid intravenous bolus),
gray mucous membrane color; prolonged capillary refill decompression (trocharization or gastric
time; tachycardia; weak pulse; tachypnea; dyspnea intubation/lavage), corticosteroids, abdominal
radiographs (right lateral most important),
surgical intervention if torsion

Gastrointestinal (GI) Obstruction (Foreign Body, Intussusception, Tumor)

Vomiting; diarrhea; red, pale, gray, or muddy mucous Fluid therapy, endoscopy, surgical intervention,
membrane color; fast or prolonged capillary refill time; abdominal radiographs, upper GI study,
abdominal pain; tachycardia; weak pulse quality; abdominal ultrasound
dehydration; tachypnea; dyspnea

Peritonitis (GI Perforation and Ruptured Prostatic Abscess)

Hyperemic; brick-red mucous membrane, rapid capillary refill Fluid therapy, appropriate antibiotics,
time, tachycardia, bounding pulse quality, hyperthermia, abdominocentesis (obtain sample for cytology),
hypoglycemia, abdominal pain diagnostic peritoneal lavage, surgical
intervention
Clinical Signs Treatment

Parvovirus Infection

Vomiting; diarrhea; pale, gray, or muddy mucous membrane Fluid therapy, antibiotics to prevent secondary
color; prolonged capillary refill time; tachycardia; weak bacterial infection, correct hypoglycemia, correct
pulse quality; dehydration; hypoglycemia; hypokalemia, antiemetics, abdominal
hypokalemia; leukopenia palpation to rule out intussusception

Liver Failure

Vomiting; hematemesis; diarrhea; melena; Fluid therapy, GI protectants, lactulose, vitamin K , 1

polyuria/polydipsia; dementia; seizures; antibiotics, fresh frozen plasma

jaundice; anemia; coagulopathy; hypoalbuminemia;
hypoglycemia; hyperbilirubinemia; hypocholesterolemia;
low blood urea nitrogen

Hemorrhagic Gastroenteritis

Hematochezia, vomiting, dehydration, lethargy, anorexia Fluid therapy, colloid replacement, GI protectants

Pancreatitis

Vomiting, diarrhea, lethargy, anorexia, painful abdomen, Fluid therapy, colloid therapy, antibiotic
pyrexia therapy, pain medication
 REPRODUCTIVE SYSTEM EMERGENCIES
Patient monitoring should include respiratory status, cardiovascular status, renal status, and temperature. Note
vomiting/diarrhea, serial database readings, and serial emergency blood screen analysis. The female patient
also should be closely observed for active contractions, vaginal discharge, and delivery. Reproductive
emergencies affecting the male often require prompt surgical intervention (Table 27-8).

TABLE 27-8
Emergencies of the Reproductive System

Clinical Signs Treatment

Pyometra

Polyuria/polydipsia, recent estrus, vomiting, Fluid therapy (isotonic crystalloid), antibiotic therapy, surgical
hyperthermia, vaginal discharge (depends intervention
on whether the cervix is open or closed),
abdominal distention

Eclampsia

Muscle tremors, evidence of whelping and lactation Calcium gluconate (slow intravenous bolus), fluid therapy (when
usually 2-3 wk before, brick-red mucous hyperthermia, isotonic crystalloid solution), oral calcium
membranes (hyperemic), tachycardia, throughout lactation, electrocardiogram while administering
bounding pulse quality, hyperthermia, calcium gluconate; if bradycardia, arrhythmia, or vomiting
hypocalcemia occurs, stop treatment

Dystocia

Active contractions for more than 30 min, more Rule out obstructive dystocia (digital examination, abdominal
than 2 hr between deliveries, green discharge radiographs), oxytocin, calcium gluconate, glucose,
with no delivery of fetus surgical intervention
TOXIC SUBSTANCE EMERGENCIES
Because of the wide variety of effects caused by toxins, it can be difficult to recognize an intoxicated patient
without a detailed history. A local poison control center or one of the national animal poison control centers
often can give treatment options to the veterinarian. A variety of plants may potentially be toxic to animals. If
plant toxicity is suspect, refer to a plant toxicity reference or contact poison control. Management of toxicity
patients involves decontamination (see following procedures), controlling clinical signs, occasionally an
antidote (if one is available for the particular toxin), and close patient monitoring. Patient monitoring should
include respiratory status, cardiovascular status (electrocardiogram), renal status, vomiting/diarrhea,
coagulopathy, and neurological status. See Table 27-9 for a list of the most common toxins.

TABLE 27-9
Emergencies Caused by Toxic Substances
Clinical Signs Treatment

Acetaminophen (Tylenol) Toxicosis

1-2 hr postingestion (salivation, vomiting, Induce emesis if less than 1 hr postingestion (not performed if
tachypnea, brown or cyanotic mucous showing signs of tachypnea), acetylcysteine, ascorbic acid, fluid
membrane color, dark or chocolate- therapy (isotonic crystalloid), supply oxygen
colored blood, edema of face)

Anticoagulant Rodenticide Toxicity

No clinical signs: ingested recently, dyspnea, Induce emesis (if recently ingested, activated charcoal, vitamin K ),
1

hematuria, hematemesis, epistaxis, prothrombin time analysis 2 days postingestion, then prothrombin
melena, hemothorax time analysis 2 days after vitamin K finished, fresh whole blood or
1

fresh frozen plasma if coagulopathy is present

Chocolate Toxicosis (Methylxanthine) (Active Ingredient Theobromine) (LD : 100 mg/kg)

50

Vomiting, diarrhea, hyperactivity, muscle Induce emesis, gastric lavage, activated charcoal, cathartics, fluid
tremors, tachycardia, arrhythmia, therapy (isotonic crystalloid), oxygen supplementation
hypertension, seizures

Ethylene Glycol Toxicity (LD : dog, 4-6 mL/kg; cat, 1.5 mL/kg)
50

Vomiting, polyuria/polydipsia, tachypnea, Gastric lavage, cathartics, fluid therapy (isotonic crystalloid), ethanol
tachycardia, azotemia, increased serum (7%), peritoneal dialysis, methylpyrazole test for ethylene glycol
osmolality, metabolic acidosis, within 12 hr of ingestion; if patient is exhibiting seizure activity,
hypocalcemia, oliguria, ataxia, seizures, obtain blood for ethylene glycol test before administration of
stupor, coma diazepam (propylene glycol in diazepam can make ethylene glycol
test falsely positive)
Clinical Signs Treatment

Lead Poisoning

Vomiting, diarrhea, lethargy, abdominal pain, Remove lead from gastrointestinal (GI) tract, enema, emetic, surgical
ataxia, blindness, seizures, evidence of intervention, remove lead from tissues and blood, calcium EDTA,
nucleated red blood cell on blood smear penicillin, control seizures
with no evidence of anemia

Nonsteroidal Antiinflammatory Drugs

Vomiting, diarrhea, GI bleeding (hematemesis, Fluid therapy (isotonic crystalloid, isotonic colloid, blood products,
melena) artificial colloid), GI protectants (sucralfate, cimetidine HCl)

Organophosphate Toxicity

Acronym: DUMBELS = diarrhea, urination, Remove toxin (bathe with soap and water), atropine sulfate,
miosis, bradycardia, emesis, lacrimation, diphenhydramine, pralidoxime (2-PAM), fluid therapy (isotonic
salivation; dyspnea, fasciculation, crystalloid), control fasciculation/seizures (diazepam or
vomiting, diarrhea, seizures pentobarbital)

PYRETHRINS

Central nervous system signs, severe muscular Bathe patient immediately, initially administer diazepam IV to effect,
twitching, hypothermia methocarbamol IV p.r.n. to effect (do not exceed 330 mg/kg/day),
hyperthermia, dyspnea fluid therapy

Philodendron/Dumb Cane (Insoluble Calcium Oxalate)

Clinical Signs Treatment

Pain and burning of throat, oral mucosa, and Will resolve without treatment
lips. Mucosal edema and dyspnea can
occur if severe

Marijuana (Tetrahydrocannabinol)

Depression, ataxia, animal appears anxious, Induce vomiting, gastric lavage, activated charcoal, place animal in a
abnormal vocalization, vomiting quiet environment

Easter and Tiger Lilies (Unknown Poison)

Anorexia, vomiting, renal failure Treat for acute renal failure (see Table 27-4)

Rhododendron Azalea (Andromedotoxins)

Salivation, diarrhea, vomiting, muscle Induce vomiting, gastric lavage, activated charcoal,
weakness, bradycardia, hypotension, electrocardiogram, fluid therapy, treat bradycardia
coma, and seizures
 EDTA, Ethylenediaminetetraacetic acid; IV, intravenously; p.r.n., as needed.
I. Decontamination procedures
A. Irrigation with water or saline
B. Bathing
C. Inducing emesis
D. Gastric lavage
E. Activated charcoal administration
F. Enema
G. Enterogastric lavage (gastric lavage and an enema)
H. Cathartics

OCULAR EMERGENCIES
Ocular emergencies can be caused by trauma, primary medical problems, penetrating foreign objects, or
increased intraocular pressure. It is essential that the eye(s) be rechecked frequently so progress can be
monitored. More complicated ophthalmic emergencies require the expertise of an ophthalmologist.
Misdiagnosis and improper treatment can lead to the loss of vision (Table 27-10).

TABLE 27-10
Ocular Emergencies

Clinical Signs Treatment

Glaucoma

Enlarged eyeball, dilated pupil, Treat with drugs, such as mannitol and pilocarpine, that will reduce IOP by
negative menace response, absent drawing fluid out of the vitreous chamber
papillary light response, corneal
edema, and pain
Diagnosis is determined by
measuring intraocular pressure
(IOP). IOP is measured by the use
of a Schitz or electronic
tonometer

Corneal Foreign Bodies and Lacerations

Blepharospasm, ocular discharge, Corneal foreign body: gentle irrigation with sterile saline to dislodge foreign
photophobia as a result of pain object, surgical intervention
Laceration: surgical intervention, topical antibiotics and atropine sulfate,
Clinical Signs Treatment

oral antibiotics

Hyphema

Hemorrhage in anterior chamber Treat underlying cause (trauma, infection uveitis, neoplasia uveitis,
coagulopathy)

Uveitis

Painful, red, inflamed iris; Topical atropine; if secondary glaucoma is present, use adrenaline
blepharospasm; miotic pupil; (epinephrine), topical corticosteroids
prolapsed nictitans; decreased
IOP; hypopyon; hyphema

Proptosis

Proptosis of eye First note severity of proptosis: enucleation, replacement of eye

Corneal Ulcers

Blepharospasm, ocular discharge, Superficial ulcers: topical antibiotics, atropine sulfate

photophobia as a result of pain Indolent ulcers (Boxer ulcers): debride edges of ulcer, keratectomy, topical
antibiotics
Deep ulcer: avoid excessive restraint, which may lead to perforation;
topical antibiotics; topical atropine sulfate; patients with melting or
infected ulcers need topical anticollagenase (autologous serum
administered every hour for the first day of treatment); Elizabethan
Clinical Signs Treatment

collar to prevent patient scratching of eye

Descemetocele

Descemets membrane penetrated Surgical intervention, topical antibiotics

through ulcer, looks transparent;
cornea is in danger of penetration
ACKNOWLEDGMENTS
The editor and author would like to recognize and appreciate the original contributions of Sally R. Powell and
Elisa A. Petrollini.

REVIEW QUESTIONS
1. A nonstable patient should receive emergency treatment within what time period?
a. Immediately
b. 5 to 15 minutes
c. 15 to 45 minutes
d. Within 1 to 2 hours

2. When a patients respiratory system is being evaluated, which of the following is being assessed?
a. Respiratory rate
b. Respiratory effort
c. Respiratory depth and rate
d. Respiratory rate, depth, and effort

3. Which of the following monitoring parameters provide information about a patients circulatory
status?
a. Mucus membrane color and CRT
b. Mucus membrane color, CRT, and heart rate
c. Mucus membrane color, CRT, heart rate, pulse rate, and pulse quality
d. CRT, heart rate, pulse rate, and quality

4. Advanced life support includes which of the following treatments?

a. Closed chest compressions and ventilation
b. Chest compressions, ventilation, drugs, defibrillation, and open chest compressions
c. Closed chest compressions only
d. Ventilation, defibrillation, and drugs only

5. What does the acronym CPCR stand for?

a. Cardiopulmonary chest resuscitation
b. Cardiopulmonary compression resuscitation
c. Cardiopulmonary cerebral resuscitation
d. Cardiopulmonary cerebellum resuscitation

6. When performing closed chest compressions on a barrel-chested dog the patient should be in
_____________ recumbency
a. Right lateral or dorsal
b. Left lateral or sternal
c. Dorsal or lateral
d. Sternal or dorsal

7. The _________ route of drug administration is an acceptable method when performing advanced life
support?
 a. IV, IO, or intratracheal
b. IV
c. IV or IO
d. IV or intracardiac

8. What does SaO (pulse oximetry) indicate about a patient?

2

a. Amount of oxygen in the blood

b. Amount of hemoglobin in the blood
c. Percentage of expired carbon dioxide
d. Percentage of hemoglobin that is saturated with oxygen

9. Aggressive fluid therapy is contraindicated in which type of shock?

a. Hypovolemic shock
b. Cardiogenic shock
c. Anaphylactic shock
d. Septic shock

10. What should the oxygen rate be when delivering oxygen via a nasal catheter?
a. 2 to 3 L/min
b. 2 to 5 L/min
c. 40 mL/kg/min
d. 100 to 150 mL/kg/min

11. In patients with head trauma the head should be elevated ____________ to decrease intracranial
pressure.
a. 5%
b. 10%
c. 30%
d. 75%

12. Hypercalcemia is a medical emergency because of its effect on which organ?

a. Kidney
b. Liver
c. Spleen
d. Heart

13. Abdominal distention, nonproductive vomiting, and muddy mucous membranes are symptoms of
which disease process?
a. GI obstruction
b. Intussusception
c. Peritonitis
d. Gastric dilation/volvulus

14. The drug of choice for treating eclampsia is:

a. Dexamethasone
b. Atropine
 c. Calcium gluconate
d. Epinephrine

15. When treating hypoglycemia dextrose must be given:

a. As a bolus
b. Diluted and as a bolus
c. SQ
d. IM

16. Puppies and kittens should be born within ________ of each other.
a. 30 minutes
b. 1 hour
c. 2 hours
d. 4 hours

17. ____________-colored mucous membranes are associated with acetaminophen (Tylenol) toxicity.
a. Pale
b. Yellow
c. Brick red
d. Brown

18. Normal urine production should be:

a. 1 to 2 mL/hr
b. 1 to 2 mL/kg/hr
c. 2 to 3 mL/kg/hr
d. 2 to 3 mL/hr

19. Using your triage skills, in which order should the following patients be seen?
1. Dog hit by car yesterday and has a small laceration
2. A 16-year-old cat has been vomiting for 3 days and has pale mucous membranes
3. Choking dog
4. Dog with fish hook stuck in lip
a. 1, 2, 3, 4
b. 4, 3, 2, 1
c. 3, 2, 4, 1
d. 2, 3, 4, 1

20. Using your triage skills, in which order should the following patients be seen?
1. Dog just hit by car and has light pink mucous membranes
2. Puppy that has been vomiting and having bloody diarrhea for 3 days and has pale mucus
membranes
3. Cat having asthma attack
4. Cat had a fight with raccoon yesterday and just came home; it has a small visible laceration only
a. 1, 2, 3, 4
b. 4, 3, 2, 1
c. 3, 2, 1, 4
d. 2, 3, 4, 1