NMVMA listserve Veterinary Behavior Tip #16
February 27, 2016
Jeff Nichol, DVM – Veterinary Behavior Medicine
Veterinary Emergency and Specialty Centers
Albuquerque and Santa Fe
Pre Exam Sedation/Anxiolysis for Fear-Aggressive Pets
Some entrenched problems are that clinics and people vary in terms of their ability to understand and handle difficult patients, and that for lifelong care, owners need to do some hard work with acclimation to muzzles at home, (basket only), ideally do sub-threshold work with driving the dog to the clinic but not getting out of car, reward, reward, driving to clinic and getting out of car and then back in, reward, reward, working up until pet can be led in and out w nothing happening, and also trial of sedation protocols days or weeks before the pet actually goes to the veterinarian. Clinic needs to schedule pet for early day or later day, needs to have owner check in and leave pet in car until time for exam, and veterinarians should charge for the extra time this takes, as patience is necessary.
Medications must be on board and WORKING before the pet has any sense that something is going to happen. For gabapentin and trazodone, this means about 2 hours prior to leaving home. The owner must be coached that wobbly sedate pets may misjudge stairs and heights, jumping from the car, or falling on stairs may occur if they aren’t supervised and restrained. The duration of sedation is variable and being quiet or emotionally flat for as much as 24 hours is normal and non-harmful. But it helps with anxiety; it has an analgesic (antihyperalgesic) component as well as sedation/ tranquilization. It is OK to give the meds in a small meatball or piece of cheese if needed, even if the patient is to be sedated or anesthetized.
- Prescribe gabapentin: 20 mg/kg PO night prior to hospital visit (lower doses for less problematic patients or those who are elderly).
- This loading dose may not be essential.
- At very least they can see how the pet will respond.
- Repeat gabapentin early morning prior to hospital visit (same dose a you used the night before).
- Add melatonin 1- 5 mg to this (1 mg for a small dog, 5 mg for a 100 Ib dog, 0.5 mg for a cat).
- Oral transmucosal acepromazine (injectable) 0.025 – 0.05 mg/kg 30 minutes prior to leaving the house.
- Don’t bother using tablets, OTM works far more reliably – as if you injected it.
- Give the dose of acepromazine that you would give 1M for sedation.
- In very old patients, you might use less, like 0.01 mg/kg,
- In very small patients you would have to dilute ace to be able to dose it accurately.
- Send home 2 doses ln case the owner spills one – no needle, just a capped syringe.
- This takes 20 – 30 minutes for onset. If owner has trained dog to muzzle, muzzle for the car ride.
When the patient arrives it may not seem very sedate. Use of muzzle and other skillful handling as necessary. To
facilitate exams and procedures, or to go to general anesthesia you will likely have to further sedate:
- Can give hydromorphone 0.1 mg/kg +/- ketamine 3 mg/kg 1M
- oxymorphone 0.1 mg/kg +/- ketamine 3 mg/kg 1M (may need 5 mg/kg in cat)
- butorphanol 0.2 – 0.3 mg/kg + ketamine 3 mg/kg 1M (may need 5 mg/kg in cat)
In muzzled pet, if tolerated, could simply place LV in hind leg (using site away from the face usually tolerated best) and give additional propofol at sedative level or dexdomitor 1M
If there is no way to get the OTM ace from the veterinarian oral trazodone can be given instead.
- 2-5 mg/kg q12-24 hours. Available in 50, 100, 150 mg. tablets. Do not be wimpy with the dose.
- Trazodone needs 2 hours to find the receptors and do its magic, and possibly even several days of loading.
Veterinarian has to be ready, work quietly, efficiently, calmly. Owners usually appreciate it very much.