ClinQuiz: Implementing the American Animal Hospital Association's Anesthesia Guidelines (Sponsored by Abbott Animal Health) Answer 3B
3 B. — Correct!
This strategy provides a multimodal or balanced analgesic approach: complementary contributions from an opioid, an NMDA antagonist, a local anesthetic nerve block, and an NSAID. Multimodal analgesic methods allow for reduced doses of each class of agent, acting at different aspects of the nociceptive process, to maximize benefits.
The pure-agonist opioid at a moderate dose (repeated postoperatively if dental extractions are needed) will be the foundation of analgesia. A low-dose of an NMDA receptor antagonist was combined with a rapidly acting hypnotic injectable anesthetic for "co-induction" of anesthesia. The NMDA antagonist also provides an excellent analgesic adjuvant benefit, supporting the contribution of other drug classes.
This strategy also addresses the potential change in analgesic requirements depending on the need for dental extractions. A local anesthetic nerve block would be performed before extraction. The specific technique for the nerve block or blocks would be based on the extraction or extractions needed, and the nerve block agent should include a rapidly acting and a longer-acting anesthetic.
For additional details, see the AAHA Anesthesia Guidelines for Dogs and Cats, the AAHA Anesthesia Guidelines Toolkit, a Toolkit supplement, a brief video,"Best Practices for Pet Anesthesia," and a webcast seminar, "The AAHA Anesthesia Guidelines in Practice."