Drug | Bolus | Initial infusion rate | Notes | |
---|---|---|---|---|
Anaesthetic induction | ||||
 | Lignocaine 1 % | 3–5 mL subcutaneously |  | Over central venous access insertion sites |
 | Buprenorphine | 300 mcg |  | Administered six hourly during protocol |
 | Midazolam | 0.5 mg/kg |  |  |
 | Alfaxalone | 3 mg/kg |  | If further boluses needed, dosed at 0.5 mg/kg |
Anaesthetic maintenance | ||||
 | Alfaxalone |  | 6 mg/kg/h | Adjusted to surgical plane |
 | Ketamine |  | 3 mg/kg/h | Adjusted to surgical plane |
 | Midazolam |  | 0.25 mg/kg/h | Used only if required (if alfaxalone exceeded 250 mg/h) |
Antimicrobial prophylaxis | ||||
 | Cefalotin | 1000 mg |  |  |
 | Gentamicin | 40 mg |  |  |
Fluid management | ||||
 | Hartmann’s solution | 10–20 mL/kg | 2 mL/kg/h | Titrated to CVP 8–12 mmHg. Boluses if needed for low urine output (<0.5 mL/kg/h) or hypotension (MAP < 60 mmHg). Initial fluid of choice |
 | Normal saline 0.9 % | 10–20 mL/kg | 1–2 mL/kg/h | Boluses if needed for low urine output (UO < 0.5 mL/kg/h) or hypotension (MAP < 60 mmHg) |
 | Dextrose 5 % or dextrose 4 % in saline 0.18 % | 10–20 mL/kg | 1–2 mL/kg/h | Utilised for hypoglycaemia (BSL < 6 mmol/L) |
Vasopressors, inotropes and cardiovascular support | ||||
 | Metaraminol | 0.5–1 mg |  | Utilised in emergency situations for hypotension only |
 | Atropine | 600 mcg |  | Utilised in emergency situations for bradycardia (HR < 60 bpm) only |
 | Noradrenaline |  | 0.05 mcg/kg/min | Adjusted to MAP > 60 mmHg |
 | Dopamine |  | 5 mcg/kg/min | Adjusted to MAP > 60 mmHg |
 | Isoprenaline |  | 0.5 mcg/min | Adjusted to MAP > 60 and HR > 60 bpm. Utilised only if considered bradycardia as cause of hypotension |
 | Glyceryl trinitrate |  | 0.1 mg/h | For hypertension (SBP > 180 mmHg) if necessary |
 | Amiodarone |  | 5 mg/kg over 2 h | Infusion for appropriate dysrhythmias (e.g. atrial fibrillation) if necessary. Could be repeated |
Hormonal management | ||||
 | Insulin | 10–20 U | 0.5 U/h | Bolus for BSL > 16 mmol/L. Infusion adjusted to BSL 6–10 mmol/L, tested hourly once infusion commenced |
 | Dextrose 50 % | 25 mL |  | For management of hypoglycaemia (BSL < 3.5 mmol/L). Please also note that dextrose 5 % could be used for ongoing maintenance per above |
 | Desmopressin | 4 mcg |  | If urine output >300 mL/h for two consecutive hours |
Hormone resuscitation at 12Â h | ||||
 | Vasopressin | 1 U | 0.5–4.0 U/h (initial dose 2.0 U/h) | Adjusted to SVR 800–1200 dyn.s.cm−5 |
 | Liothyronine | 4 mcg | 3 mcg/h |  |
 | Methylprednisolone | 15 mg/kg |  |  |
Electrolyte management | ||||
 | Potassium chloride |  | 10–40 mmol/h | Adjusted to potassium 3.5–5.0 mmol/L |
 | Calcium chloride 10 % | 6.8 mmol |  | Administered to keep ionised calcium > 1.05 mmol/L |
 | Magnesium sulphate | 10–20 mmol |  | Allowed for management of dysrhythmias (e.g. atrial fibrillation) |
Euthanasia | ||||
 | Sodium pentobarbitone | 100 mg/kg |  |  |