de Vries Marieke, Putter Gerhard
Davies Veterinary Specialists, Higham Gobion, UK
All Animal Dental Centre, Sudbury, UK Email:
J Feline Med Surg. 2015 Jan;17(1):23-36. doi: 10.1177/1098612X14560096.
Anaesthesia for dental and oral procedures in cats can be challenging and many factors need to be taken into consideration. Often it is older patients requiring these procedures and, while old age itself is not a contraindication for general anaesthesia, older patients tend to have limited homeostatic reserves and are, therefore, more prone to anaesthesia-induced insults of vital organs. Most sedative and anaesthetic agents have cardiovascular side effects, which may result in detrimental consequences in older patients in which organ reserves are likely reduced.
The need for good patient assessment and management during the entire perianaesthetic period cannot be overemphasised. This article describes how both anaesthetic protocol and intravenous fluid therapy should be tailored to the individual cat's needs. Application of a multimodal analgesic protocol (the combination of different analgesic agents) and a balanced anaesthetic technique incorporating local nerve blocks is highly recommended and a particular focus of the review. The use of local anaesthetic agents for the latter not only provides optimal pre-emptive analgesia, but also reduces the amount of anaesthetic agents needed to maintain an adequate level of anaesthesia and, therefore, limits their side effects. Other key aspects of perianaesthetic care of the feline dental and oral patient include airway protection, monitoring and maintenance of body temperature, eye protection, and analgesia extending well into the post-anaesthetic period.
The authors draw on their clinical experience and the referenced literature to provide a practical overview of this critical but often-overlooked aspect of feline dentistry.
猫牙科和口腔手术的麻醉具有挑战性，需要考虑许多因素。通常需要进行这些手术的是老年患者，虽然高龄本身并非全身麻醉的禁忌证，但老年患者的体内稳态储备往往有限，因此更容易受到麻醉引起的重要器官损伤。大多数镇静剂和麻醉剂都有心血管副作用，这可能会给器官储备可能减少的老年患者带来不利后果。
在整个围麻醉期对患者进行良好的评估和管理的必要性再怎么强调都不为过。本文描述了麻醉方案和静脉输液治疗应如何根据每只猫的需求进行调整。强烈推荐应用多模式镇痛方案（不同镇痛剂的联合使用）以及结合局部神经阻滞的平衡麻醉技术，这也是本文综述的一个特别重点。使用局部麻醉剂进行后者不仅能提供最佳的超前镇痛，还能减少维持足够麻醉水平所需的麻醉剂用量，从而限制其副作用。猫牙科和口腔患者围麻醉期护理的其他关键方面包括气道保护、体温监测与维持、眼部保护以及术后长时间的镇痛。
作者借鉴他们的临床经验和参考文献，对猫牙科这一关键但常被忽视的方面提供了实用概述。
