Dogs with cardiac disease undergoing dental procedures are not at significantly increased risk for anesthetic complications when managed by trained personnel with careful monitoring. The key protocol modifications center on drug selection, balanced anesthesia to reduce volatile agent requirements, and hemodynamic support. Journal of the…

Premedication should favor opioids combined with midazolam rather than alpha-2 agonists. Midazolam and etomidate are used more frequently, and alpha-2 agonists less frequently, in cardiac patients compared to healthy controls undergoing dental procedures. Journal of the… For patients with pulmonary hypertension or right-sided disease, methadone (0.2 mg/kg IM) combined with midazolam (0.3 mg/kg IV) and lidocaine (1 mg/kg IV) provides cardiovascularly stable premedication. Frontiers in Ve… In ASA III–IV patients with coexisting disease, an opioid alone or an opioid-benzodiazepine combination is appropriate, avoiding the hemodynamic burden of acepromazine or dexmedetomidine. WSAVA Global Gu…

Induction should use etomidate or a ketamine-propofol combination to preserve cardiovascular stability. Etomidate is preferred in cardiac patients. Journal of the… A ketamine (1 mg/kg IV) plus propofol (2 mg/kg IV) combination has been used successfully in dogs with severe cardiac disease and pulmonary hypertension undergoing dental extractions. Frontiers in Ve… All induction agents should be administered to effect to minimize cardiorespiratory depression. WSAVA Global Gu…

Maintenance with isoflurane or sevoflurane should be kept at the lowest effective concentration using a balanced, MAC-sparing approach. High concentrations of volatile agents cause peripheral vasodilation, reduced myocardial contractility, and reduced cardiac output, which is poorly tolerated in compromised patients. WSAVA Global Gu… Continuous infusions of lidocaine (30–50 μg/kg/min) and remifentanil (10–30 μg/kg/h) serve as effective inhalant MAC-sparing adjuncts in cardiac patients. Frontiers in Ve…

Regional dental nerve blocks are a critical component of the cardiac dental anesthetic plan. Local anesthetic dental blocks dramatically decrease the depth of general anesthesia required, thereby supporting blood pressure, decreasing ventilatory depression, and providing analgesia. AAHA Clinical G… This directly reduces the volatile agent load on the compromised cardiovascular system. WSAVA Global Gu…+1

Hemodynamic support should be proactive. In patients with pulmonary hypertension, a norepinephrine infusion (0.2–0.4 μg/kg/min) to maintain mean arterial pressure above 65 mmHg is appropriate. Frontiers in Ve… Controlled ventilation targeting normocapnia and titrating inspired oxygen fraction to maintain SpO₂ above 95% while avoiding unnecessary hyperoxia is recommended in patients where intracardiac shunt dynamics are a concern. Frontiers in Ve…

Preoperative workup for senior cardiac dental patients should include renal function (creatinine) and cardiac biomarker assessment (N-terminal pro B-type natriuretic peptide), with imaging as indicated. Preoxygenation is recommended for patients with cardiovascular or pulmonary illness. AAHA Clinical G… Preprocedural IV fluids should be considered in patients where fasting may compound existing compromise. AAHA Clinical G… Eye lubrication should be applied at least hourly throughout the procedure, as tear production is reduced under sedation and general anesthesia. WSAVA Global Gu…

Would you like guidance on which specific dental nerve block techniques are recommended for maxillary versus mandibular procedures?