CKD Cat With Hypertension Scheduled for Dental Extractions

The creatinine of 2.6 mg/dL with a urine specific gravity of only 1.021 is consistent with IRIS stage 2 chronic kidney disease; the cat cannot concentrate urine well, and the total solids of 8.2 g/dL plus the increased water intake suggest a mild dehydration component. The PCV of 30% is a mild anemia that may be renal in origin. The systolic pressure of 168 mmHg on three readings is borderline-to-mild hypertension and should be treated as a real risk, not ignored. The mobile premolar and possible resorptive lesion mean extraction pain and a longer procedure than a simple cleaning.

Compared with a healthy cat, I would insist on a pre-operative IV catheter and baseline electrolytes, avoid meloxicam and robenacoxib because of the renal disease, and build analgesia around opioids such as buprenorphine or hydromorphone plus local nerve blocks. I would induce with alfaxalone or propofol to effect and maintain on isoflurane at the lowest effective concentration. Ketamine is not absolutely contraindicated, but I would not choose it as a routine induction agent in this cat. I would monitor blood pressure every 5 minutes, keep the cat warm, and plan fluids at a conservative rate rather than a high rate.

At 3 mL/kg/h for a 4.8 kg cat, the rate is 14.4 mL/h. That is a reasonable conservative intraoperative rate for a cat with CKD and probable mild dehydration; a higher rate risks volume overload, especially if the cat is older and has cardiac changes that have not been investigated. I would use a balanced isotonic crystalloid, start the fluid before induction if possible, and record the rate and the total volume on the anesthesia sheet.

If systolic pressure fell to 85 mmHg for 5 minutes, I would first check the reading and the cuff placement, then tell the veterinarian immediately. I would assess anesthetic depth and ask whether the vaporizer setting can be reduced, check heart rate and rhythm, check the pulse quality, and confirm the fluid line is patent. If the veterinarian agrees, I would give a 5 to 10 mL/kg bolus, which is 24 to 48 mL over about 15 minutes, and reassess. I would not simply increase the fluid rate indefinitely without reassessing, because this cat cannot tolerate a large volume load. I would also watch respiratory rate and lung sounds for signs of overload.

For analgesia I would use buprenorphine 0.01 to 0.02 mg/kg IV or IM every 6 to 8 hours, or hydromorphone 0.05 to 0.1 mg/kg, and combine it with local anesthesia such as a mandibular nerve block with bupivacaine at no more than 2 mg/kg. Opioids avoid the renal risk of NSAIDs, and the local block reduces the intraoperative anesthetic requirement and provides post-extraction comfort. I would not send the cat home with meloxicam or robenacoxib given the creatinine and urine specific gravity.

Discharge instructions would include offering soft food and water, avoiding hard chew toys, checking the extraction sites for bleeding or swelling, and watching for decreased appetite, lethargy, or vomiting. I would explain that some drooling and reluctance to eat for 24 hours can be normal but should be reported if it persists. I would schedule a recheck in 7 to 10 days for the mouth and in 2 to 4 weeks for renal values and blood pressure. I would also make sure the owner understands that the dental disease and the kidney disease both need ongoing management, and I would document the NSAID avoidance clearly in the record.