Clinical sedation and Premedication

Question 1

When can sedation be used as an alternative to anaesthesia?

Answer 1

In non-invasive or non-painful procedures

Question 2

What are some reasons to sedate an animal?

Answer 2

• Relieve patient anxiety
• Facilitate patient handling
• Provide analgesia
• Provide muscle relaxation
• To enable procedures or interventions to be carried out

Question 3

What are some reasons to premedicate an animal?

Answer 3

• Smooth induction, maintenance and recovery of general anaesthesia
• Reduce required dose for induction/maintenance agent
• MAC sparing effect

Question 4

What are some factors that an ideal sedative/premed would have?

Answer 4

• Safe
• Reliable and predictable effect
• Quick onset with an appropriate duration of action
• Easy to administer
• Minimal side effects
• Provide analgesia

Question 5

Drugs for food producing animals must have what?

Answer 5

Maximum residue limit

Question 6

What could be used in equine species pre-appointment to relieve anxiety?

Answer 6

Acepromazine oral gel

Detomodine oromucosal gel

Question 7

What drugs can be used in dogs and cats pre-appointment to relieve anxiety?

Answer 7

Gabapentin

Trazadone

Question 8

Give some example of opioid drugs

Answer 8

Butorphanol
Buprenorphine 
Methadone
Fentanyl
Morphine

Question 9

In which situations will opioids be adequate on their own?

Answer 9

• Very painful animals e.g. fracture, urinary infection

- Very sick animals

Question 10

Which system can become depressed after opioid administration?

Answer 10

Respiratory

Question 11

Which anaesthetic drug is a part of the phenothiazine group?

Answer 11

Acepromazine

Question 12

What are some downsides of using acepromazine?

Answer 12

• No analgesia
• Onset = 20-40mins (long)
• Not reversible

Question 13

In which cases would Acepromazine not be suitable?

Answer 13

• Very young (<3 months)
• Hepatic impairment
• Haemorrhage (actual or anticipated)
• Anticipated hypotension during general anaesthesia
• Sepsis

Question 14

Give some drug examples of Alpha-2 agonists

Answer 14

Xylazine
Detomidine
Romfidine
Medetomidine
Dexmedetomidine

Question 15

What are some side effects of alpha-2 agonists?

Answer 15

• peripheral vasoconstriction, then reflex bradycardia
• reduced cardiac contractility
• increased urine production

Question 16

What are some of the advantages of alpha-2 agonists?

Answer 16

• Almost immediate onset of action
• Very reliable sedation
• Analgesia
• Reversible
• Large MAC sparing effect

Question 17

Which drug acts to reverse alpha-2 agonists?

Answer 17

Atipamezole

Question 18

Benzodiazepines are useful for which types of patient?

Answer 18

Very old
Very young
Very sick

Question 19

What are the pros and cons or benzodiazepines?

Answer 19

Pros:
- Minimal side effects
- Relatively fast onset
- Reversible
Cons:
- Unreliable sedation
- No analgesia

Question 20

In which species are benzodiazepines not suitable?

Answer 20

Farm animals

Question 21

Propofol can only be administered via which route?

Answer 21

IV

Question 22

Ketamine can be useful as an adjunct in which type of cases?

Answer 22

Cases which need additional analgesia

Aggressive cases to increase sedation reliability

Question 23

Which 3 drugs can be used in farm animal species?

Answer 23

Butorphanol
Xylazine
Detomidine

Question 24

Ruminants are particularly sensitive to which alpha-2 agonist? how does this affect the dose?

Answer 24

Xylazine

- Use 1/10th of the dose you would use for a horse

Question 25

Which drug group provides reliable sedation of horses?

Answer 25

Alpha-2 agonists

Question 26

Why would acepromazine be added following equine sedation?

Answer 26

To smooth recovery

Question 27

In which equine cases would you not use acepromazine and why?

Answer 27

Colic because of vasodilation effects

Question 28

In horses why would you administer an alpha-2 agonist first and then an opioid 5 minutes later?

Answer 28

If not given like this it can cause excitation from the opioid