Lecture 28: Sedation for Dx & Therapeutic Procedures (Exam 4) Flashcards
Define tranquilization
Results in behavior changes & relief of anxiety
Define sedation
State characterized by central depression accompanied by drowsiness. the px is gen unaware of its surroundings but responsive to painful stimuli
Define immobilization
Gen used in wildlife/exotic ax that implies the px is rendered incapable of movement
What are the reasons for sedation or ax
- To provide analgesia, muscle relaxation, & a lack of awareness in order to provide a safe surgical experience
- Restraint for examination
- Safe transportation
- Dx & therapeutic procedures
- Euthanasia
- Humane slaughter of food animals
Describe how heavy sedation for dx or therapeutics you approach
- Depending on the practice
- Neuroleptanalgesic approach common used
- Unless the physical status of the px warrants a more cautious approach
- Consider reversal for a short procedures
Describe how you approach premed during gen ax
- Depends on the prac
- An IM does is gen 2x what the IV dose would be
- There is no need to “make them a rug” unless the px is fractious
- Neuroleptanalgesic approach is common but is species & px dep
Why might a px be difficult to handle
- Stress in the hospital envi
- White coat syndrome
- More preventable than treatable
- Proper handling skills may be outmatched by the animal & cause injury on personnel & themselves
- Px may have a pre existing painful condition
Describe fear free or low stress handling
- Allow cats to assoc positive experiences w/ the carrier
- Pay attention to the body language
- Consider a separate waiting area for cats & dogs
- Feliway can be helpful
- Avoid reaching into the carrier/shacking the cat out
- Place a non slip pad on the table & utilize towel wraps
- Use this approach first
Are felines predators or prey
Prey animals
How do you know when sedation is needed
- Px showing visible sx of FAS
- Not wanting to interact
- Not taking treats or toys
- When they are resisting give them breaks
- May consider considerations
What medications can owners give at home before the visit
- Gabapentin to cats or dogs just be sure they have intact kidney function
- Selio for dogs w/ noise phobia/aversion
- Trazodone often used for anxious dogs but can give to cats
- Alprazolam can be give to treat ax
- Clonidine before the car ride or event
What are some considerations for oral meds
- Be sure to warn the owner of all potential complications
- Px may seem sedated until stimulation occurs
- Don’t give diazepam orally to cats b/c it can cause hepatic necrosis
What is the chill protocol
What can happen with giving melatonin to dogs
May cause hallucinations & worsen aggression in some px
T/F: Anxiety is cured
False; anxiety is treated & not cured
T/F: Aggression is a symptom not a dx
True
What is a neuroleptanalgesic approach
- A sedative or tranquilizing drug + opioid
- Synergistic effect
Describe procedural sedation
- Zenalpha alone or w/ butorphanol IM
- Only select for ASA 1 or II dogs
- Not used in cats b/c of hypotension
- 5 to 15 min onset
- About 45 min duration
- Less profound CV effects
- Vomiting unlikely
- Reversal typically not req
Why is benzodiazepines used w/ cautions in mod nervous, fearful, or fractious px
Paradoxical excitement may be seen in healthy px
Why is ace used w/ cautions in mod nervous, fearful, or fractious px
- Many side effect
- No reversal agent so prolonged recovery
- Unreliable sedation
What can occur w/ a difficult dog
- Drug will likely go IM
- Select approp needle length in overweight/obese px
- Keep in quiet dark room
- Refrain from stiming the px until drugs have taken effect
- Ideally the placement of the IVC after sedation has kicked in
- Consider the addition of ketamine IM to dex or hydro/morphine
Describe alfaxalone
- Used IM to produce sedation
- Alfaxalone + a2 agonist, ace, midazolam, &/or an opioid for better recovery
- Min CV effects so ideal for a sicker px
- Works quickly but doesn’t last long
What can be done w/ the difficult cat
- “Kitty Magic”
- Dex + opioid of choice
- Remember ketamine can be sprayed in the mouth
- Telazol IM
- Alfaxalone + opioid
+ midazolam IM - a strong combo of injectable drugs can be selected to facilitate to shelter animals
Describe what to do w/ the difficult old & sick px
- Midazolam is a better choice than a2 agonist or ace
- Combine midazolam w/ morphine or hydrom
- Paradoxical excitement can occur but usually not when they are really sick
- Consider using alfaxalone w/ midazolam & an opioid
What should be avoided
- Ketamine alone
- Ace alone
- Benzos in young & health px
- Diazepam IM has poor absorption & is painful
List some reversal agents
- Yohimbine, tolazoline, & atipamezole reverse a2 agonist
- Flumazenil reverses benzos
- Naloxone reverses full mu receptor opioid agonists
How do controlled substance laws effect the vet clinic & you
- Controlled substance act
- DEA license
- Ordering & storage controlled substances
- Controlled drug log
- Refills, labeling, & disposal
Fill out the following chart
Define General ax
Drug induced unconsciousness by controlled but reversible depression of the CNS. The px is not aroused by noxious stimu
