====== Narkose Hund ======

===== Sedation =====

  * Butorphanol (Alvegesic® 0,3 ml / 10kg)
  * Alpha-2-Agonist + Opioid
      * Medetomidin (Narkostart® 0,1ml / 10kg ) \\ +
      * Methadon (Comfortan® 0,1ml / 10kg)
      * Butorphanol (Alvegesic® 0,1ml / 10kg)
  * Acepromazin
  * Valium + Ketamin in Mischspritze –> 1ml / 10 kg

===== Sedation aggressiver Hunde oral (Dr. Angela Dyer) =====

  * Acepromazine
      * 0.55 to 2.2 mg/kg p.o
      * Its use as a sole oral sedative is questionable at best. It is poorly absorbed when given with food. Many vets have found this to be an unreliable sedative. Many dogs appear sedated, but can easily overcome their sedation with any stimulus, leading to unpredictable behavior. Or, even worse, leading to a false sense of security on the part of the staff or veterinarians with the inevitable consequence of injury.
  * Diazepam
      * bis 2.2 mg/kg p.o.
      * It is important to remember that it can have a disinhibitory effect on certain patients. Removing what little inhibition the patient may have to bite you is less than ideal.
  * Pentobarbital
      * bis 60mg/kg vor Eutha möglich
  * Alprazolam (Xanax)
      * 0.1mg/kg bei Angstzuständen (in extremen Fällen 0.5mg/kg)
  * Telazol & Acepromazine
      * one paper *see below advocated the use of telazol powder at 20mg/kg mixed in food. This combination had predictable, heavy sedation when combined with 2.2mg/kg acepromazine PO. Keep in mind that 7 of 8 dogs were sternally recumbent and reluctant to stand. 6 of 8 dogs were laterally recumbent and unable to maintain sternal recumbency. The patient may need to be kept in the hospital until able to ambulate.
  * One of our members has used telazol at 10 mg/kg (using the injectable solution) with acepromazine at 2.2 mg/kg and found a very attractive, balanced level of restraint with sternal recumbency in an otherwise insanely wild 25 kg canine. This patient was able to ambulate within 5 hours of the medication’s administration.
  * Other Combinations: Several other combinations have also been described:
      * Acepromazine 1.25mg/kg + Diazepam 0.5mg/kg
      * Butorphenol + Diazepam
      * Phenobarbital 2mg/kg + Diazepam 1mg/kg

===== Prämedikation =====

^Risikogruppe^Wirkstoffe^Bemerkung|
|ASA I-III|Acepromacin 0,02-0,05 mg/kg|mind. 30 Min vor Einleitung|
| |Acepromacin 0,01-0,05 mg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Methadon 0,1-0,3 mg/kg|Analgesie 2-4 Std|
|ASA I-II|Medetomidin 1-40 µg/kg|nie bei kranken Tieren|
| |Medetomidin 1-20 µg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Butorphanol 0,2 mg/kg|nie bei kranken Tieren|
| |Medetomidin 1-20 mg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Ketamin 1-3 mg/kg|nie bei kranken Tieren, Schock_PARA__TABLE_INS__PARA__TABLE_INS_Antisedan frühestens nach 30 Min|
| |Medetomidin 1-20 µg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Ketamin 1-3 mg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Butorphanol 0,2 mg/kg|nie bei kranken Tieren, Schock_PARA__TABLE_INS__PARA__TABLE_INS_Antisedan frühestens nach 30 Min|
|ASA III-V|Midazolam 0,1-0,4 mg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Ketamin 1-5 mg/kg|Wirkung i.m. nach 15 Min|
| |Midazolam 0,1-0,4 mg/kg_PARA__TABLE_INS_+_PARA__TABLE_INS_Methadon 0,1 mg/kg|gute Sedierung mit Analgesie_PARA__TABLE_INS__PARA__TABLE_INS_paradoxe Reaktion bei ASA I-II möglich|
|ASA V|Midazolam 0,1-0,8 mg/kg|keine Analgesie, nur Anxiolyse|
| |Methadon 0,1-0,3 mg/kg|bei Schmerzhaften Eingriffen|

===== spezielle Narkoseprotokolle =====

==== Gehirn-OP ====

  * ETCO2 hoch → erweitert Gefäße → Hirndruck
  * Prä-OP: Methylprednisolon
  * OP: Mannitol

==== neurologische Patienten ====

  * Kontraindikation
      * Ketamin bei Schädel-Hirntrauma (steigert Gehirnmetabolismus)
      * α-2-Agonisten (senken BD, steigern Vagotonus, Erbrechen), Acepromazin
      * Kortison ist out
      * ​​​​​​​große Flüssigkeitsboli
  * Prämedikation
      * ​​​​​​​Methadon 0,1 mg/, Fentanyl 2-5 µg/kg
      * Diazepam 0,2mg/kg
  * ​​​​​​​Einleitung mit Propofol

==== Atemwegserkrankungen ====

  * Narkosen mit respiratorischer Dysfunktion muss O2 gegeben werden
  * bei Eröffnung des Thorax ist eine IPPV notwendig (auch bei Zwerchfellhernien)
  * hohe Ventilationsdrücke sollten vermieden werden bei chronisch kollabierten Lungenlappen und Pneumonie

===== Quellen =====

  * Ramsay EC, Wetzel RW (1998): Comparison of Five Regimens for Oral Administration of Medication to Induce Sedation in Dogs Prior to Euthanasia. J Am Vet Med Assoc 213: 240-242.