Sedation and premedication

Question 1

when could sedation be used instead of anaesthesia?

Answer 1

for non-invasive and non-painful procedures

Question 2

what is the point of sedating or premedicating a patient?

Answer 2

relieve anxiety of patient
facilitate handling
provide analgesia (pre-emptive)
produce muscle relaxation
smooth induction, maintenance and recovery
reduced dose of induction/maintenance agents (MAC sparing)

Question 3

what properties would the ideal premedicant or sedative have?

Answer 3

relieve fear and anxiety
safe
reliable/predictable
quick onset and appropriate duration of action
easy to administer (volume, route…)
minimal cardiovascular, respiratory and other side effects
provide analgesia

Question 4

what can be used to sedate a horse pre-appointment?

Answer 4

acepromazine gel
detomodine oromucosal gel

Question 5

what can be used to sedate dogs/cats at home pre-appointment?

Answer 5

gabapentin
trazadone

Question 6

when should gabapentin be given to an anxious patient prior to an appointment?

Answer 6

2 hours before

Question 7

what cases should you be cautious about using trazadone as a pre-appointment sedative?

Answer 7

patients with history of seizures

Question 8

what are the options for sedation and premedication?

Answer 8

opioids
phenothiazines
alpha 2 receptor agonists
benzodiazepines

Question 9

what opioids are available to use?

Answer 9

butorphanol
buprenorphine
methadone
fentanyl
(morphine - isn’t licensed)

Question 10

what animals is morphine often used as a sedative/premedicant?

Answer 10

horses - cascaded to from methadone as they get facial twitching

Question 11

what is the phenothiazine used in sedation/premedication?

Answer 11

acepromazine

Question 12

what are the examples of alpha 2 agonists used for sedation/premedication?

Answer 12

xylazine
detomidine
romifidine
medetomidine
dexmedetomidine

Question 13

what are some benzodiazepines used for sedation/premedication?

Answer 13

diazepam
midazolam

Question 14

what patients may an opioid be enough for sedation?

Answer 14

very painful or ver sick animals (fractures, sepsis…)

Question 15

what is a main side effects do opioids have?

Answer 15

respiratory depression (should stop you from using it)

Question 16

what is the main side effect of acepromazine?

Answer 16

vasodilation

Question 17

what cases would acepromazine be considered for?

Answer 17

mitral valve disease (doesn’t cause vasoconstriction)
BOAS patients
laryngeal paralysis or URT disease

Question 18

how good is the sedation from acepromazine?

Answer 18

unreliable - some patients sedate well others don’t

Question 19

does acepromazine provide analgesia?

Answer 19

no

Question 20

is acepromazine reversible?

Answer 20

no

Question 21

what are some patients that acepromazine not be suitable for?

Answer 21

very you (<3 months old)
hepatic impairment (struggle to metabolise)
haemorrhage
anticipated hypotension
sepsis

Question 22

what is the duration of action of acepromazine?

Answer 22

long (4-6 hours)

Question 23

what are the side effects of alpha 2 agonists?

Answer 23

peripheral vasoconstriction then reflex bradycardia
reduced cardiac contractility
increased urine output

Question 24

how good is the sedation from alpha 2 agonists?

Answer 24

very reliable

Question 25

do alpha 2 agonists provide analgesia?

Answer 25

yes

Question 26

are alpha 2 agonists reversible?

Answer 26

yes (atipamazole)

Question 27

what can be used to reverse alpha 2 agonists?

Answer 27

atipamazole

Question 28

what are some patients that alpha 2 agonists shouldn’t be used in?

Answer 28

mitral valve disease
very young (<3 months old)
if bradycardia would be problematic
urinary obstruction

Question 29

what general cases are benzodiazepines useful for?

Answer 29

very young, very old, very sick

Question 30

what are the side effects of benzodiazepines?

Answer 30

minimal

Question 31

how good is the sedation achieved from benzodiazepines?

Answer 31

unreliable

Question 32

do benzodiazepines provide analgesia?

Answer 32

no

Question 33

are benzodiazepines reversible?

Answer 33

yes (flumazenil)

Question 33

what can be used to reverse benzodiazepines?

Answer 33

flumazenil

Question 34

what are some patients that benzodiazepines wouldn’t be suitable for?

Answer 34

farm animals
portosystemic shunts

Question 35

what are some possible adjuncts to are usual sedatives/premedicants?

Answer 35

propofol
alfaxalone
ketamine
physical restraint

Question 36

how can opioids be administered?

Answer 36

IV
IM
SC
transcutaneous (fentanyl)

Question 37

how can acepromazine be administered?

Answer 37

IV
IM
SC
oral (gels and tablets)

Question 38

how can alpha 2 receptors agonists be administered?

Answer 38

IV
IM
SC
transmucosal

Question 39

how can benzodiazepines be administered?

Answer 39

IV
IM (midazolam)
oral (diazepam)
rectal

Question 40

what are the licensed drugs for farm animals?

Answer 40

butorphanol, xylazine, detomidine

Question 41

what precaution needs to be taken when giving xylazine to ruminants?

Answer 41

they are very sensitive to it (need 1/10 as much as equines)

Question 42

what is a major complication of ruminants be very sensitive to xylazine?

Answer 42

can get pulmonary oedema

Question 43

what order should alpha 2 agonists and opioids be administered in horses?

Answer 43

alpha 2 agonist first then opioid 5 minutes later (don’t mix them)

Question 44

why should alpha 2 agonists be administered before opioids in horses?

Answer 44

don’t get the excitation caused by opioids

Question 45

what equine cases should acepromazine be avoided in?

Answer 45

colic (vasodilation is an issue)