Hyperthermia After Dental

[MaryJane]

Curious to know if this "Vet Tech" is licensed???

 

I didn't ask as I felt that the vet should handle the internal dynamics of this situation. Although, she is relatively new there as I have been going close to 10 years and I've only seen her the last few months.

 

Ok ... you made me curious - I checked the website - it appears that she still might be in school.

[tbhounds]

I didn't ask as I felt that the vet should handle the internal dynamics of this situation. Although, she is relatively new there as I have been going close to 10 years and I've only seen her the last few months.

 

Ok ... you made me curious - I checked the website - it appears that she still might be in school.

 

She needs to stay in school.

[Batmom]

All the drugs Krissy mentioned (great post BTW) are legal and are used in the US.

 

 

Drugs aside, some dogs really fuss at the vet. Sometimes you don't know that in advance. If you do, it's worth discussing with the vet and arranging fast in, fast out for any procedures or other appointments. I had one whose temp could zip up to 105 just from a few minutes in the waiting room.

[greyhoundparty]

On 5/19/2017 at 1:37 PM, krissy said:

Sorry, I was working yesterday and then I had an ultimate game in the evening and got home really late.

 

 

Here's the unfortunate reality for sighthounds. They're more sensitive to almost all drugs compared to other breeds, and pain control is necessary with surgical procedures. And further to the point of opiates... there aren't many injectable pain medications or sedatives that aren't opiates.

 

Non-opiate sedatives: Ketamine, Acepromazine, Dexdomitor, Diazepam/Midazolam.

 

Ketamine is a heavy hitter in my experience so I usually only use it on very aggressive, healthy patients. No pain control and HAS to be given with something else to avoid nasty side-effects, usually with Diazepam or Midazolam, otherwise with an opiate.

Acepromazine can be a problem for greyhounds. OSU uses it at very low doses and that seems to be okay usually (0.5 mg total per hound, not mg/kg). No pain control. But frankly, I've never been a huge fan of Ace and I rarely use it on any patient anymore, regardless of breed.

Dexdomitor is a dream, but is generally avoided in senior patients or those with known/suspected heart conditions. I love it. Heavy sedation that I can reverse - patient is out like a light in seconds to minutes and then awake again within minutes of getting the antidote. No pain control.

Diazepam/Midazolam provides only very mild sedation. We typically combine it with an opiate to use for elderly or debilitated patients. No pain control.

 

Non-opidate pain killers (injectable): NSAIDs

NSAIDs have no sedative effect, can't be given to patients with kidney concerns or GI concerns or those that are dehydrated or debilitated.

 

Opiates: Hydromorphone, Butorphanol, Buprenorphine, Morphine

All of these drugs provide pain control as well as sedation and can be given by any injectable route in most cases, and in some cases can also be given orally.

Butorphanol is the mildest, providing the least pain control and the least sedation. However, it is typically my choice of opiate for sighthounds as it doesn't tend to cause dysphoria. That said though, any dog can have a bad reaction to any drug as evidenced by Macoduck's Allen who had a pretty significant adverse reaction to Butorphanol. Those reactions can't be anticipated.

 

Anesthetizing greyhounds makes even ME stressed out. It's a no win scenario. If I don't use enough drugs then the dog is painful after surgery... and owners don't tend to like it when their dog is really painful (understandably!). If I use heavy opiates and get better control on pain then the dog is probably going to be dysphoric (panting, anxious, crying, etc), and even if no actual complications (like the temperature spike)... again, owners don't like it when their dogs are dysphoric (understandably!). If I do what I would do with my own dog, then the dog is quite sedate for an extended period of time (but not dysphoric and not painful)... and owners also don't like that. I do my sighthound patients early in the day and then keep them very late before sending home.

 

 

When I had Kili spayed I used a huge concoction of drugs. She was sedated with Butorphanol/Dexdomitor. Then once her IV was placed I started a low dose constant rate infusion of Lidocaine/Ketamine/Dexdomitor. I ran this constant rate infusion of these 3 drugs all through surgery and for several hours after. She unfortunately had to be an afternoon surgery, finished around 4:30 PM, so I went home and ate dinner before coming back to get her. I took her home on her triple drip of drugs, and I ran it all evening and for most of the night. It ran out around 2AM. On those drugs she was comfortable and very sedate. I was personally very pleased with this protocol and will probably do the same when I decide to spay Kenna. It controlled pain very well. And because she was sleepy/sedate I didn't have a dysphoric dog crashing around after waking up suddenly. She woke up and then basically went back to sleep (rousable but reluctantly) and then once the infusion stopped it took another few hours to clear all the drugs so she woke up nice and slowly through the night. Problem is, I don't think this is a protocol you can really use on a client greyhound, but gosh it was amazing.

 

 

 

When I did Summit last year at almost 11 years old, I did Butorphanol/Midazolam for his sedation. However, he only had a very small lump to come off and a routine dental cleaning with no extractions... so pain was a minor factor. When he had surgery for his spine a few months later I left it up to the referral centre. I have no idea what they used for the actual anesthesia, but I do know that they had him on a drip of methadone afterwards so he was super sedate for hours after (but not dysphoric). That dog seems to handle his opiates okay which is fortunate.

 

Greyhounds suck to anesthetize sometimes. I totally agree. However, avoiding necessary care because of the risks of anesthesia is not any better for the dog. Girls that aren't spayed get cancers and life-threatening uterine infections. Boys can get testicular cancer. Bad teeth lead to a host of other health concerns and is incredibly painful. Anesthesia is a risk in ANY breed, and yes it can be even a little scarier for those of us with sighthounds. But trust me, living with a rotten mouth is not something any dog would choose. I know it is difficult and scary, but I would encourage you to continue to perform anesthetic procedures when they are necessary. Do as much as you can at home to avoid needing anesthetic procedures (brush teeth daily, use a water additive, use a dental diet if possible, give dental treats, get lumps checked out early, etc) and do anesthetic procedures earlier than later. A routine dental cleaning is way easier on a hound than one with a bunch of extractions... pain control is a problem as we've already discussed and anesthetic time is very much prolonged by needing to do a lot of work. And finally, use a vet that you are comfortable with. And by comfortable, I mean that if something goes wrong (and it can with any dog or cat or rabbit or human) that your first reaction won't be "I've lost trust in them" but "I know they took the best care of him that they could".

 

 

I'm very sorry this happened to you and Adam, and I'm so glad he's doing better.

Old thread but wanted to come here to say wow you really know your stuff! My girl needs a dental with extractions ASAP, she had to be under for another procedure one year ago and did ok but seemed to take 24 hours to seem normal again and wake up fully. She had half open eyes no blinking for HOURS at home recovering and it was scary. Seemed so out of it like not responsive so I did not give the second dose of butorphanol they sent us home with, so glad I didn’t. Im extremely hesitant to have this dental but she has a chunk of molar that broke off so I have little choice. Thank you!