#29 – Fear Aggressive Dogs in the Veterinary Clinic
Make it Simple & Easy for Everybody
Dormosedan: Owner-administered oral transmucosal (OTM) sedation
There are a few dogs who will bite anybody, including their owners. But the great majority of those who direct their aggression toward the veterinary clinic staff are frightened and defensive/reactive. They would readily bite us but they are fine with their owners.
An easy way of simplifying this challenge for everybody will be to give the owner a carefully measured dose of the equine-approved oral transmucosal sedative Dormosedan (detomidine) for them to administer outside-before they lead their dog into the clinic. The dog never becomes reactive because the problem has been preempted.
Preventing the ramp-up of fear is important. Each time a pet is exposed to the sights, sounds, and scents of the scary environment of the veterinary clinic they become increasingly sensitized. Their fear is more intense with each exposure because the brain’s neural circuits become stronger and the long-term memories stored in the hippocampus become more deeply ingrained. Rodeos, firm restraint, risks to the pet and staff, and client anxiety serve no one. All of that angst is avoidable.
I have done physical exams, administered vaccinations, drawn blood and urine, treated wounds, and in a few cases positioned dogs for x-rays under Dormosedan. In cases where deeper sedation is necessary you can top-off the OTM Dormosedan with IM Dexdomitor +/- Torbugesic. A 50% dosage reduction in these injectables has provided deep sedation in cases where the OTM Dormosedan hasn’t provided enough.
The procedure for using Dormosedan is simple and reliable.
- Detomidine (Dormosedan) gel concentration is 7.6 mg/ml.
- For sedation, Dormosedan gel can be dosed at 4.5 – 6.0 mg/m2. I use the higher dose.
- Time to effect: 50-60 minutes
- Dormosedan can be reversed with the IM atipamazole (Antisedan) dose you would use for the same size dog having gotten an IM sedative dose of dexmedatomidine.
The client procedure:
- I explain to the client that rather their dog struggling during the visit they can easily administer an oral transmucosal sedative called Dormosedan.
- The client leaves the dog in their car when they arrive at the veterinary clinic.
- They are handed a 1 ml syringe (no needle) with Dormosedan at the reception desk.
- You have premeasured this for them based on the dog’s surface area converted from its weight in kg.
- I meet briefly with the client to show them how and where to place the gel.
- To demonstrate I put cotton tipped applicator between my own lower lip and gum adjacent to the last molar.
- I explain that if the dog swallows the Dormosedan it will be degraded by digestive enzymes and have no effect.
- Outside the clinic the client can smear the end of the 1 ml syringe with peanut butter, raise the dog’s head, and slowly and gently slide the syringe between the lower lip and gum, near the back of the dog’s lower dental arcade.
- They can then deposit the gel, hold the mouth closed and in an upward position for about 2 minutes to allow the gel to absorb across the mucus membranes.
- Meanwhile, your staff has set aside a dark exam room with a comfy towel/pad on the floor. With an extra folded towel and a basket muzzle on the counter, the stage will be set.
- After administering the Dormosedan the client leads their dog into the vacant, dark exam room.
- Visual and auditory stimuli are avoided.
- Nobody pops their head into the room to ask how things are going.
- This would be counterproductive as it would risk rousing the dog.
- The owner is instructed, that after 45-50 minutes, they are to put the basket muzzle on their dog and cover its head with the towel.
- When the doctor and nurse enter the room at 50-55 minutes post Dormosedan administration the light is switched on (the dog’s head is covered) and voices are kept very low.
- When the work is done you can turn up the lights and remove the towel from the dog’s head.
- Most dogs simply stagger to their feet and lumber out the door.
- If the dog is too sleepy for this the doctor can give IM Antisedan.
- I inform clients that this will reverse the sedation in 10-15 minutes.
I always tell my clients that Dormosedan is not approved for use in dogs. We have one robust research study supporting its safe and effective use. I have used Dormosedan in multiple cases; it has worked reliably for many veterinary behaviorists and general practitioners.
While Dormosedan is reversible with Antisedan (atipamezole) I have seldom found it necessary. After removal of the towel from the dog’s head a few pushes and nudges have been sufficient to rouse the pet to consciousness. They stagger to their feet and wobble out the door. Their people are very happy that there was no struggle.
Dormosedan is available from MWI Veterinary Supply. Depending on the size of the dogs you treat, you can usually dose 5-6 dogs/syringe. Owners of dogs with a history of freaking-out in the veterinary clinic are delighted that their pet was treated gently. They are happy to spend real money for that quality of care. You can order Dormosedan from any veterinary supplier.
Finally, below I have included a reference to the research paper on Dormsedan use in dogs.
I hope you find this information helpful. I invite you to peruse and use any of the information from this and past nmvetlist missives. You will find the entire archive on the For Veterinarians page of my website, drjeffnichol.com/
My website also contains a large content of blogs, videos, and podcasts –intended for pet owners – on the care of dogs and cats. Your clients are welcome to have a look.
All the best,
Jeff Nichol, DVM
Veterinary Behavior Medicine
Veterinary Emergency and Specialty Centers
Albuquerque and Santa Fe
I invite you to peruse and use any of the information from this and past nmvetlist missives. You will find the entire archive on the For Veterinarians page of my website, drjeffnichol.com/
Journal of Veterinary Behavior 8 (2013) 114–123
The use of oral transmucosal detomidine hydrochloride gel to facilitate handling in dogs
Marie J. Hopfensperger a,1, Kristen M. Messenger b, Mark G. Papich b, Barbara L. Sherman a,