Lecture 28: Sedation for Diagnostic & Therapeutic Procedures

What results in behavior changes and relief of anxiety, so that the patient appears calm, stress is reduced, and it may appear indifferent to minor pain?

tranquilization

What is the term generally sued in wildlife/exotic anesthesia that implies the patient is rendered incapable of movement?

immobilizaiton

What is the state characterized by central depression accompanied by drowsiness where the patient is generally unaware of its surroundings, but may respond to painful stimuli?

sedation

What is drug-induced unconsciousness by controlled, but reversible depression of the CNS where the patient may respond to, but is not aware of stimuli?

general anesthesia

What are the reasons for for sedation or anesthesia?

• Analgesia, muscle relaxation and a lack of awareness to provide a safe surgical experience for staff AND patient

▪ Restraint for examination

▪ Safe transportation of wild and exotic animals

▪ Diagnostic & therapeutic procedures

▪ Euthanasia

▪ Humane slaughter of food animals

How do you approach premedication prior to general anesthesia

• pre-meds may be given by multiple routes

• an IM dose is generally 2x what the IV dose would be

• combination of drugs for different effects?

How would you approach sedation for a diagnostic or therapeutic procedure?

• Multiple routes but often IM or IV

• Sedative + analgesic combos mostly

• How much relaxation? Nail trim vs wound closure? Is a local block possible?

• I try very hard NOT to reverse unless really needed

Why might patient handling be difficult?

• patient stressed in hospital environment

• patient may have a pre-existing painful condition

What are the non-pharmacologic approaches for patient stress/handling?

fear free → low stress handling

How do you know when sedation is needed?

• Patient showing visible signs of fear, anxiety or stress

• Does the patient allow you to interact?

• Will the patient take a treat or show interest in a toy?

• If the patient begins to resist during the exam ➔ give them a break

• If struggling continues when exam is resumed ➔ consider sedation or call is quits for the day

What are some medications for owners to give at home before an office visit to mitigate stress?

• gabapentin

• trazodone

• combo of both

What are the benefits and risk of using medications such as gabapentin or trazodone before visits?

Benefits: anxiolysis, sedation, mild analgesia,

Risks: May cause ataxia and heavier sedation in some, always discuss with owners

Why can diazepam not be given orally to cats?

can cause hepatic necrosis

What is the “chill protocol”?

• gabapentin the evening before

• gabapentin and melatonin at least 1-2 hours before appointment

• acepromazine 30 mins before appointment

What drug can be added to the “chill protocol”?

trazodone

What is a multi-modal approach to analgesia?

• Add a local anesthesia technique if pain anticipated during procedure

• NSAIDs for treating inflammation and pain

• Acetaminophen for dogs → NOT CATS

What can zenalpha cause in cats?

hypotension

What drug class can cause paradoxical excitement in excited or fractious patients?

benzodiazepines

Why does acepromazine have a prolonged recovery period?

there is no reversal agent

What drug can be given IM to produce sedation, but volume could be a concern in larger dogs?

alfaxalone

What is “kitty magic”?

ketamine + dexmedetomidine + butorphanol

What sedative is a good choice in sick, debilitated patients?

midazolam combos

What is the reversal agent of alpha 2 agonists?

atipamezole

What is the reversal agent of benzodiazepines?

flumazenil

What is the reversal agent of full mu-receptor opioid agonists?

naloxone

What drug class are alfaxalone, diazepam, midazolam, and butorphanol?

schedule IV

What drug class are ketamine and buprenorphine?

Schedule III