University of Florida College of Veterinary Medicine Syllabus Template I. Course information Course Title: VEM 5472, Small Animal Anesthesiology Phase: III Semester: Spring Course credit: 1 Course Grading: Letter II. General information Course director: Tiffany Granone Office location & office hours: by appointment only Office phone number – Email: [email protected] Course Faculty: Fernando Garcia, Andre Shih, Darryl Heard, and Jennifer Bornkamp III. Course description Course goals; Educational goals of the course: Provide students the principles and knowledge necessary for the practice of safe anesthesia in small animals; Guide the students in solidifying their knowledge and understanding of small animal anesthesiology by relating what they experienced in the anesthesiology clerkship. Course objectives: Provide students the essential information for a safe practice of small animal anesthesia; guide the students in applying physiology and pharmacology in small animal anesthetic practice; point out the principles behind the techniques they experienced in the anesthesiology clerkship Course Outline & schedule: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Anesthetic machines used in small animal practice Monitoring of anesthetized small animal patients Choosing injectable agents in small animal practice Principles and application of total intravenous anesthesia Drugs used in the epidural space in small animals Clinical use of muscle relaxants in small animals Anesthesia for small animal patients with specific diseases Choosing inhalant agents in small animal practice Perioperative pain management Perioperative use of NSAIDS in small animals Anesthesia of small mammals Perioperative cardiac dysrhythmias: recognition and management Local anesthetic techniques in small animals Management of anesthetic complications in small animals Anesthetic management of emergency cases Specialized ventilation in anesthetized small animal patients

Schedule TOPIC Introduction to the course Anesthetic machine for small animals Monitoring in small animals Choosing injectable agents in small animal practice TIVA Drugs used in the epidural space of small animals Clinical use of muscle relaxants in small animals Anesthesia for small animal patients with specific diseases (Part 1) Anesthesia for small animal patients with specific diseases (Part 2) Choosing inhalant agents in small animal practice Perioperative pain management Perioperative use of NSAIDS in small animals

Anesthesia of small mammals Perioperative cardiac dysrhythmias: recognition and management Local anesthetic techniques in small animals Management of anesthetic complications: Part 1 Management of anesthetic complications: Part 2 Emergency anesthesia Specialized ventilation in small animals FINAL EXAMINATION Equine Auditorium IV. Course Materials Include Learner Objectives and Key words for each IU 1. Lecture: Introduction and Small Animal Anesthetic Machines (1 IP) Keywords: High-pressure system, Low-pressure system, Breathing systems, Scavenging system, Oxygen, E tanks, H tanks, Nitrous oxide (N2O), Pressure regulation, Oxygen Flush Valve, Flow control valves, Flow Meter, Vaporizers, Non-Rebreathing Systems, Rebreathing Systems, Bain Coaxial System, Jackson-Rees system, Closed system Objectives: 1. To discuss the operation of the small animal anesthetic machines and the breathing circuits. 2. To present the breathing circuits commonly used in small animal practice 3. To discuss the use and operation of the closed-system anesthesia 4. To compare the vaporizer out the circuit and the vaporizer in circuit systems. 2. Lecture: Perioperative Pain Management in Small Animals (1 IP) Keywords: Pain, Pre-emptive, pathologic pain, central sensitization, postoperative analgesia, balanced analgesia, epidural, constant rate infusions, opioids, lidocaine, ketamine, acupuncture Objectives: 1. To discuss the assessment of pain in small animals 2. To present the different nociceptive concepts as they are applied in small animals 3. To discuss the different techniques used in perioperative pain management in smalls animals. 4. To discuss the differences between dogs and cats when providing perioperative analgesia 3. Lecture: Anesthetic Complications in Small Animal Anesthesia (2 IPs) Keywords: Perivascular Injection, Anaphylaxis, Anaphylactoid, Anesthetic Overdose, Vomiting, Regurgitation, Tachypnea, Endobronchial Intubation, Hypoxemia, Airway Obstruction, Hyperthermia, Malignant hyperthermia Objectives: To prepare the students in the management of less common anesthetic complications in small animals when they occur 4. Lecture: Monitoring Anesthesia in Small Animals (1 IP) Keywords: Auscultation, Electrocardiograph, Electric heart rate meter, Capillary refill time, Arterial Blood Pressure monitoring (indirect and direct), Doppler ultrasound, Oscillometric, Mucous membrane, Pulse oximetry, Capnography Objectives: 1. To discuss in more details the different monitoring tools that can be used in small animals including the principles of each monitoring tool 2. To discuss the significance of the findings from the different monitoring tools used in small animals 3. To present the different abnormalities seen in capnography

5. Lecture: Neuromuscular Blocking Agents in Small Animals (1 IP)

Keywords: Depolarizing, Non-depolarizing, Atracurium besylate, Pancuronium bromide, Vecuronium, Peripheral nerve stimulator, Monitoring neuromuscular blockade, Technique of relaxant anesthesia, Train of four, reversal, edrophonium, neostigmine, Failure to return to spontaneous respiration Objectives: 1. To present the various clinical situations where neuromuscular blocking drug will be helpful. 2. To classify the neuromuscular blockers used clinically 3. To identify the neuromuscular blocking agents commonly used in the clinic 4. To discuss the clinical usage of neuromuscular blocking agents including monitoring and reversal of neuromuscular blockade 5. To identify the causes of failure to restore spontaneous respiration 6. Lecture: Choosing Inhalation Agents in Small Animal Anesthesia (1 IP) Keywords: Halothane, Methoxyflurane, Enflurane, Isoflurane, Sevoflurane, Desflurane, Boiling point, Saturated Vapor Pressure, Blood Solubility, Minimum Alveolar Concentration (MAC), Metabolism, Degradation by Carbon Dioxide Absorbents, Odor Comparison, Induction, Recovery, Arrhythmogenicity Objectives: 1. To discuss the properties of an ideal inhalation agent 2. To review the properties of inhalation agents and their clinical significance 3. To compare the relatively “new” inhalation agents with the “old” ones 4. To discuss the advantages and disadvantages of the available inhalation agents 5. To come up with logical reasoning when making a decision as to the best inhalation agent in small animal practice 7. Lecture: Ferret, Rabbit and Rodent Anesthesia and Analgesia (1 IP) Keywords: Fasting, Stabilization, Premedication, Parasympatholytics, Phenothiazines, Benzodiazepines, Alpha-2 Adrenergic Agonists, Analgesia, Parenteral Anesthesia, Dissociative Anesthetics, Ketamine, Tiletamine, Propofol, Inhalant Anesthetics, Anesthetic Depth, Auscultation, Capillary Refill Time, Electrocardiography, Doppler Flow Detection, Arterial Blood Pressure, Dehydration, Respiratory, Blood Gas Analysis, Pulse Oximetry, Capnography, Thermoregulatory, Fluid Therapy, rabbits, rodents, ferrets Objectives: 1. To discuss the preoperative considerations, preparation and handling that are specific to small mammals 2. To present the important aspects of pre-anesthetic medication in small mammals. 3. To enumerate and discuss the different anesthetic induction and maintenance methods available for small mammals 4. To address the monitoring of anesthetized small mammals 5. To discuss the important points when recovering small mammals from general anesthesia 8. Lecture: Injectable Anesthetic Techniques in Small Animals and Total Intravenous Anesthesia (2 IPs) Keywords: Single injection, Continuous infusions (CRIs), Total intravenous anesthesia (TIVA), Barbiturates, Non-barbiturates, Alpha2-agonists, Thiopental, Propofol, Ketamine, Telazol, xylazine, Etomidate, Dexmedetomidine, Objectives: 1. To discuss how to select appropriate injectable induction and/or maintenance agents to suit each patient 2. To discuss the side-effects and contraindications of the injectable agents 3. To discuss the principles and practice of total intravenous anesthesia 9. Lecture: Anesthesia for small animal patients with specific diseases (2 IPs) Keywords: Cardiovascular disease, congenital anomalies, congestive cardiac failure, Pulmonary disease, ruptured diaphragm, Gastrointestinal disease, Hepatic disease, portosystemic shunts, Renal disease, Valvular Insufficiency, Arrhythmias – VPCs, Endocrine Diseases, Diabetics, Insulinoma, Hyperthyroidism, Addison’s

Disease, Cushing’s Disease, Intracranial Mass, C-section, Hemorrhagic Shock, hypovolemia, Brachycephalics, Obesity Objectives: 1. To learn how to adjust anesthetic protocols in compromised patients 2. To review pertinent principles of physiology, anatomy, medicine and surgery of complex cases 10. Lecture: Local Anesthesia in Small Animals (1 IP) Keywords: Lumbar Epidural Block, Intravenous Regional Block, Brachial Plexus Block, Infraorbital Nerve Block, Mental Nerve Block, Mandibular Alveolar Nerve Block, Maxillary Nerve Block, Retrobulbar Block, Epidural in cats, blocks for declawing Objectives: 1. To describe the local anesthetic techniques that can be done in small animals as part of balanced anesthesia 2. To discuss the area desensitized, procedures that can be performed and possible complications of each local anesthetic technique 11. Lecture: Perioperative Use of Non Steroidal Anti-Inflammatory Drugs (NSAIDs) in Small Animals (1 IP) Keywords: NSAIDs, Cyclooxygenase, Lipoxygenase, Arachidonic acid, Antipyretic, Analgesic, Antiinflammatory, Gastric irritation/ulceration, Renal damage/failure, Extended clotting time. Objectives: 1. To know how to safely and effectively administer NSAIDs in the peri-operative period in order to provide analgesia 2. To discuss the commonly used NSAIDs in the perioperative period 12. Lecture: Management of Cardiac Arrhythmias During Small Animal Anesthesia (1 IP) Keywords: Conduction Disorders, Sinus Rhythm, Sinus Arrhythmia, Sinus Bradycardia, Sinus Tachycardia, Atrial Premature Complexes APC’s, Atrial Fibrillation, Atrial Tachycardia, Ventricular Rhythms, Ventricular Premature Complexes VPC’s, Ventricular Tachycardia, Ventricular Fibrillation, Ventricular Asystole, Pulseless Electrical Activity, Second Degree AV Block, Third Degree AV Block, Antiarrhythmic agents Objectives: 1. To recognize the most common cardiac arrhythmias during anesthesia 2. To discuss the significance and management of each arrhythmia during anesthesia 13. Lecture: Drugs Used in the Epidural Space in Small Animals (1 IP) Keywords: Epidural injection, Local anesthetics, Opioids, α-2 agonists, ketamine, NSAIDs and Benzodiazepines (BZDs) Objectives: 1. To discuss the mechanism of action of the drugs placed in the epidural space 2. To discuss the clinical use of the epidural administration of these different agents in small animals 14. Lecture: Emergency Anesthesia (1 IP) Keywords: preoperative stabilization, injectable drugs, balanced anesthesia, gastric dilatation volvulus, septic patients, trauma, ruptured urinary bladder, specific postanesthesia care Objectives: 1.To discuss the principles of preoperative stabilization in emergency cases 2.To discuss the appropriate premedicants, injectable agents, inhalation anesthetic on specific emergency cases. 3.To discuss the monitoring tools essential in emergency cases 4.To discuss the supportive care needed for emergency cases during anesthesia

5.To discuss the specific concerns during the postoperative period on emergency cases 15. Lecture: Specialized ventilation in anesthetized small animal patients Keywords: hypoxemia, hypercapnia, positive-end expiratory pressure, high-frequency ventilation, intermittent mandatory, assist control, pressure control, pressure support Objectives: 1.To discuss the indications for specialized ventilation in anesthetized small animal patients 2.To discuss the different types of specialized ventilation 3.To discuss the advantages and disadvantages of each specialized ventilation Required texts: none Recommended/ Reference texts: SCAVMA notes Grimm KA, Tranquilli WJ, Lamont LA: Essentials of Small Animal Anesthesia and Analgesia 2nd ed, WileyBlackwell, 2011. Carroll G: Small Animal Anesthesia and Analgesia, Blackwell, 2008. V. Evaluation/ Grading/ Testing: Give the grading scheme – Letter Grade The grades will be based on the following scale: A 90-100 A87-89 B+ 84-86 B 80-83 B77-79 C+ 74-76 C 70-73 C67-69 D+ 64-66 D 60-63 D57-59 E 56 and lower Accommodations for Students with Disabilities - Students requesting accommodations must first register with the Dean of Students Office, Disability Resource Center at 352-392-8565. Students may also apply on-line for accommodations. For more information, see the Disability Resource Center website at: http://www.dso.ufl.edu/drc/ The Disability Resource Center will provide a letter to the student who must then meet with the course instructor to discuss the required accommodations. Once notification is complete, the instructor can work with the Disability Resource Center to provide the requested accommodations. To ensure that necessary accommodations are provided in a timely manner, it would expedite this process if any student who might need an accommodation would notify the course coordinator during registration.

VI. Administrative Policies: see Student Handbook @ http://www.vetmed.ufl.edu/education/documents/studentHandbook.pdf Honesty Policy - All students registered at the University of Florida have agreed to comply with the following statement: “I understand that the University of Florida expects its students to be honest in all their academic work. I agree to adhere to this commitment to academic honesty and understand that my failure to comply with this commitment may result in disciplinary action up to and including expulsion from the University.” In addition, on all work submitted for credit the following pledge is either required or implied: “On my honor I have neither given nor received unauthorized aid in doing this assignment.” To review the student honor code please visit: http://www.dso.ufl.edu/judicial/honorcodes/honorcode.php Plagiarism includes any attempt to take credit for another person’s work. This includes quoting directly from a paper, book, or website, without crediting the source. Sources should be noted, a link to the website added, or quotation marks placed around the material and attributed , even during online discussions. However, the instructor expects more than simply cutting and pasting in this graduate-level course. Students are expected to review, evaluate and comment on material they research, rather than simply copying relevant material. Work will be graded accordingly.

Student Evaluation of Instruction - Evaluations are performed electronically at the end of the course. To evaluate the instructor, visit the UF Evaluation site at: https://evaluations.ufl.edu/evals/

VII. Other information: The final grade will come from the final examination. The final examination will be made up of multiple choice questions. (for example): Sample test questions Multiple choice questions for the final exam: A white, female Maltese weighing 6-kg was anesthetized for phacofragmentation. Atracurium (total dose:1.0 mg) was given intravenously during the procedure. At the end of the procedure, the animal was breathing spontaneously and the reversal agent was not given. When the dog swallowed, the endotracheal tube was pulled out. In about one minute, the dog turned blue. If you were the anesthetist, what would you do next? A. B. C. D. E.

Administer neostigmine IV immediately. Stimulate the dog vigorously. Intubate and ventilate immediately. Put the animal in the oxygen cage. Attach the nerve stimulator and test for neuromuscular blockade.

When ketamine is used by itself as an IV induction agent in unpremedicated dogs, which of the following will most likely to occur? A. B. C. D. E.

bradycardia histamine release seizure vomiting bronchospasm

Extra credit assignments- none Hints on studying – Attendance and listening to lectures will help the students understand the more difficult concepts in small animal anesthesia.