In the recent webinar "Best Anaesthesia Protocols for Everyday Emergencies," sponsored by Livisto, Dr. Thaleia-Rengina Stathopoulou provided invaluable insights into the practical applications of anaesthesia in various emergency scenarios. Dr. Stathopoulou's extensive background in veterinary anaesthesia and analgesia, honed through her academic and professional experiences across Europe, has equipped her with a wealth of knowledge that she generously shared during the session. Below, we explore some of the key points discussed during the Q&A segment of the webinar. 

Epidural Anaesthesia in Cats with Blocked Urethra 

Monika Januchta inquired about the feasibility of using epidural anaesthesia in cats with a blocked urethra. Dr. Stathopoulou confirmed that epidural anaesthesia could indeed be utilised, particularly if one is proficient in performing caudal epidurals. She emphasised the importance of ensuring the animal is cardiovascularly stable and not in shock before proceeding. 

Lidocaine for Treating Arrhythmias 

Lauren Reeve asked about the mechanism and administration route of lidocaine in treating arrhythmias. Lidocaine, a class Ib antiarrhythmic, works by blocking sodium channels and shortening the action potential. It is administered intravenously and is the only local anaesthetic that can be given this way. Dr. Stathopoulou warned of the need to monitor the toxic total dose closely, especially during continuous infusion, and advised against its use in cats. 

Source for CPR Algorithm 

An anonymous attendee sought the source of the CPR algorithm discussed. The algorithm can be found at this link.

Etomidate's Effect on Blood Pressure in GDV Cases 

Kyrollos Salib queried how Etomidate affects blood pressure in Gastric Dilatation-Volvulus (GDV) cases. While Etomidate is generally cardio vascularly stable, it depletes cortisol levels, making it unsuitable for critically ill patients. 

Micro Dosing with Medetomidine Intra-operatively 

Jenny Balwant's question about micro dosing with medetomidine led to a discussion on the various applications and reasons for using this approach, such as additional sedation or analgesia. Dr. Stathopoulou suggested considering continuous infusion as an alternative. For more detailed information, she provided a useful link to a relevant article here

Lidocaine Bolus and Continuous Rate Infusion (CRI) 

Amy Shuttleworth asked about the timing between a lidocaine bolus and starting a CRI. Dr. Stathopoulou recommends administering the lidocaine bolus slowly for over 15-20 minutes and then starting the infusion immediately without any waiting time in between. She suggested a bolus dose of 1-2 mg/kg IV and an infusion rate of 30-80 mcg/kg/min, starting at the lower end. 

Managing Panting/Unsettled Bitches Post-Spay 

Emily Slevin sought advice on the best drug protocol for managing panting or unsettled behaviour in bitches post-spay. Dr. Stathopoulou highlighted the importance of providing additional analgesia due to pain from ovarian manipulation. She suggested options such as an additional dose of opioids, a small dose of alpha-2 agonists (1-2 mcg/kg), or local anaesthetic infiltration, preferably lidocaine, to the ovarian pedicle. 

Use of Lidocaine in Cats 

Helen Good's query about using lidocaine for blocks in cats was addressed with caution. While intravenous lidocaine is not recommended for cats, Dr. Stathopoulou confirmed that it can be used for regional and local anaesthesia as long as the total toxic dose is calculated and not exceeded. 

Sympathetic System Exhaustion and Ketamine 

Lizzie Sawday asked about identifying sympathetic system exhaustion before using ketamine. Dr. Stathopoulou explained that animals showing signs of depression, hypotension, hypovolemia, or compromised perfusion might have depleted catecholamines, making ketamine a less suitable option due to its negative inotropic effects. 

Autotransfusion from Bleeding Mass in Abdomen 

Mihaela Gherman asked about autotransfusion from a bleeding mass in the abdomen. Dr. Stathopoulou advised against it in cases of suspected contamination (urine, bile, faeces) or neoplasia. She provided a link to a paper detailing a two-syringe technique for autotransfusion here

The webinar, led by Dr. Thaleia-Rengina Stathopoulou, provided a comprehensive overview of various anaesthesia protocols for emergency situations, addressing numerous specific queries from participants. The depth of information and practical advice shared highlights the importance of continual learning and adaptation in veterinary practice. The session not only underscored Dr. Stathopoulou’s expertise but also her dedication to enhancing veterinary care through education and practical guidance.