Chemical restraint and analgesia in the horse

Chemical restraint in the standing horse is used for a variety of procedures in veterinary medicine. The choice of agent depends on the physical status, temperament, and size of the patient; the procedure to be performed; and safety for the patient, veterinarian, and owner. The combination of certain agents may provide more desirable restraint and analgesia than does the use of individual agents. The use of analgesics in the horse is not without side effects, some of which may be detrimental to the patient's condition. Analgesics should be chosen with these untoward effects in mind. Draft breeds possess differences that may provide a challenge to the practitioner. One such difference is their clinically apparent increased sensitivity to tranquilizers and sedative-hypnotics; consequently, reduced dose regimens for chemical restraint should be employed initially.     

Chemical restraint in ruminants.

Physical restraint is generally required when working with food animal patients. Adding a degree of chemical restraint can make many procedures more pleasant for both practitioner and patient. The enhanced level of patient cooperation improves efficiency, offsetting the modest additional cost of the drugs used. Chemical restraint techniques used in ruminants range from mild sedation of standing patients to semianesthetized recumbency.     

Chemical restraint for surgery in the standing horse.

Chemical restraint can be a useful pharmacologic tool to assist the veterinarian performing surgery in the standing horse. The agents discussed impose minimal adverse side effects and are considered relatively safe when administered in the doses described. Acetylpromazine, the most widely used tranquilizer, produces mild sedation but no analgesia. The use of tranquilizers for surgical procedures requires the combined use of either a local anesthetic technique or a sedative-hypnotic or opiate to provide analgesia. Sedative-hypnotics such as xylazine and detomidine or opiates such as morphine and butorphanol are commonly used. The sedative-hypnotics also can induce deep CNS depression and may be sufficient alone for many procedures. Opiates may be used to supplement the analgesia produced by sedative-hypnotics or provide analgesia to the tranquilized horse. Opiates are not useful alone because of their potential to cause CNS excitement in the horse. The combination of detomidine and butorphanol is probably the most effective drug combination to facilitate painful surgery in the standing horse.     

Restraint and anaesthesia of primates

The methods available for the restraint and anaesthesia of captive primates are discussed, emphasising the differences between the techniques for primates and those for other mammals; the importance of humane methods of physical restraint is emphasised. The agents available for chemical restraint and surgical anaesthesia are considered in terms of their ease of administration, the dose rate required, speed of induction and recovery, analgesic properties, muscle relaxation and side effects. New agents are available which are potentially useful in primates.     

Sedation and anesthesia of pet rabbits

Pet rabbits frequently become stressed when handled and may require sedation or chemical immobilization for procedures such as blood collection, IV catheter placement, radiography, deep ear cleaning, and dentistry. Common surgical procedures requiring general anesthesia include spay, castration, gastrotomy, cystotomy, and orthopedic procedures. Rabbits may be difficult to safely sedate or anesthetize. Individual rabbits may have varying sensitivity to the depressant effects of anesthetics. The apparent sensitivity of the rabbit's respiratory center to anesthetic drugs and the narrow range between anesthetic and toxic doses in this species add to the unpredictable character of rabbit anesthesia. Furthermore, mortality following anesthesia and surgery in sick rabbits is common. Strategically, safe anesthesia of rabbits must include the planning of procedures so that anesthetic time is minimized. Clinicians must be on guard for individual variation in response to drugs. Minimizing the use of cardiovascular depressant agents, use of agents with a high therapeutic index, and careful titration of doses to effect, along with thorough cardiorespiratory monitoring, will permit attainment of appropriate anesthetic depth with the widest margin of safety. This article presents several injectable and inhalant anesthetic protocols that may assist in effective management of many types of rabbit patient.     

Sedation of Pet Birds

Sedation of pet birds has become an increasingly popular technique to facilitate common clinical procedures, such as physical examination, blood collection, or radiography. Sedation provides immobilization, reduces vocalization, and attenuates the stress response caused by manual restraint. Midazolam and midazolam-butorphanol are the most commonly used drugs for sedation of pet birds, and they provide dose-dependent sedation with no significant side effects if used at the published dosages. The intranasal route of administration is a noninvasive alternative to intramuscular administration and has been shown to be a safe and effective technique to rapidly induce sedation in pet birds. Reversal with flumazenil should be performed in most cases of midazolam or midazolam-butorphanol induced sedation, in order to achieve rapid and complete recovery.     

Anesthesia techniques used for field castration of 10 intractable horses

Dealing with an intractable horse is a reality for nearly every equine or mixed animal veterinarian. Establishing an adequate level of sedation prior to induction of anesthesia for various clinical procedures involves little margin for error regarding the safety of the veterinarian, handler, and patient. This is further compounded by the extreme difficulty of gaining venous access required to obtain rapid and reliable results. This case series describes a technique of intramuscular sedation used for field castration of 10 captive, formerly wild horses, which may be useful for various other types of intractable horses.Key clinical message:An alternative method to sedate intractable horses for induction of anesthesia is outlined. The techniques described are accessible for most veterinary practitioners, providing small-volume, fast, and reliable intramuscular sedation.     

Kick injuries of veterinarians during examination and treatment of horses: a retrospective study in Switzerland

The risk of injury to veterinarians treating horses is high, particularly when performing painful procedures. The present retrospective study investigated this risk, including the frequency and severity of kick injuries, by submitting questionnaires to 700 veterinary practitioners in Switzerland. Evaluation of 216 completed questionnaires revealed that the frequency of kick injuries was affected by the professional experience of the veterinarian, veterinarians being an owner of a horse, the season, the type of procedure, the percentage of equine patients in the practice population, the treatment location (stall, pasture) and chemical restraint of the patient. Severe injuries incurred by veterinarians in recent years were few in number and the result of a number of unfortunate circumstances, which included hurried procedures due to time restraints and unforeseen events that frightened the patient. The risk factors derived from the full statistical model are the percentage of equine patients in the practice population, the treatment location, the type of procedure and chemical restraint of the patient. Using this information, it should be feasible to reduce the risk of injuries. Sedation of horses undergoing painful procedures, choosing a safe treatment location and caution on the part of the veterinarian are advised to reduce the number of injuries.     

Local and regional anesthesia in cattle.

Although general anesthesia commonly is used in cattle, there are some risks with its use. Local or regional anesthesia is safe and effective and is still the most desirable procedure in many situations. Many surgical procedures can be performed safely and humanely in cattle by using a combination of physical restraint, mild sedation, and local or regional anesthesia. Local anesthetic techniques are usually simple, inexpensive, and provide a reversible loss of sensation to a relatively well-defined area of the body.     

Chemical capture of impala (Aepyceros melampus): A review of factors contributing to morbidity and mortality

Objective

To review the factors that contribute to morbidity and mortality of impala undergoing chemical capture, and discuss how they are potentially mitigated.

Clinical evaluation of medetomidine, a novel sedative and analgesic drug for dogs and cats

Medetomidine, a potent alpha 2-adrenoceptor agonist, was investigated in open, multicenter clinical trials with patients of various canine and feline breeds (1736 dogs and 678 cats). The purpose of the study was to find an optimal dose of medetomidine for sedation and analgesia in clinical practice and to study how well the intended procedure could be performed under the influence of the drug. The mean dose (i.m.) of medetomidine used for examinations, clinical procedures and minor surgical interventions was 40 micrograms/kg, and for radiography 30 micrograms/kg. In cats the dose was 80-110 micrograms/kg. On the doses chosen, almost all animals were recumbent and 72% of the dogs and 85% of the cats were in a slight anaesthetic stage, unable to rise. The evaluation of the overall suitability of medetomidine (% of cases) in different indications was "very satisfactory" or "satisfactory" in 95% of dogs and 81-96% of cats. Side effects reported were limited almost exclusively to vomiting and muscle jerking in dogs (12% and 0.5% of the cases) and to vomiting in cats (65%). Medetomidine seems to suffice for pharmacological restraint of dogs and cats. The concomitant use of medetomidine (80-100 micrograms/kg) and ketamine (7 mg/kg) in cats (n = 295) provided a good anaesthesia (20-40 min). The recovery was smooth. The present study shows that medetomidine provides an effective level of sedation and analgesia for clinical use.     

Clinical efficacy and safety of dexmedetomidine and buprenorphine, butorphanol or diazepam for canine hip radiography

OBJECTIVES: To investigate the usefulness of dexmedetomidine for restraint and sedation during hip radiographic examination of hip-extended or stress-radiography views when combined with either buprenorphine, butorphanol or diazepam. METHODS: One hundred and twenty-seven client-owned clinically healthy golden retrievers or rottweilers were enrolled in a clinical trial that compared hip-extended and PennHIP methods for diagnosing hip dysplasia and were randomly allocated to receive dexmedetomidine or medetomidine in combination with buprenorphine, butorphanol or diazepam. Subjective assessments were made for response to pain, response to noise, palpebral reflex, muscle tone and overall quality of sedation; non-invasive physiological variables were also recorded. RESULTS: Overall quality of sedation was graded as good or excellent for dogs administered with a combination of butorphanol or diazepam. However, more dogs that received a combination involving buprenorphine had overall a relatively poorer quality of sedation and required additional administration of buprenorphine before the radiographic procedure could commence. Once sedated, clinically sufficient muscle relaxation accompanied by a very low proportion of dogs responding to pain or noise stimuli were observed in all treatment groups. Heart and respiratory rate, and procedure and recovery times were similar for all treatment groups, and no adverse events were observed during the study. CLINICAL SIGNIFICANCE: Dexmedetomidine sedative protocols, particularly in combination with butorphanol and diazepam, can be used effectively and safely in dogs for radiographic procedures.     

Impact of sedation method on the diagnosis of hip and elbow dysplasia in Swedish dogs

Our objective was to investigate the effect of sedation method on the screening result for hip and elbow dysplasia. The study was based on a questionnaire survey of routines for hip and elbow screening at Swedish veterinary clinics and results of hip and elbow status, for eight breeds (Bernese Mountain Dog, Boxer, German Shepherd Dog, Golden Retriever, Labrador Retriever, Newfoundland, Rottweiler, and Saint Bernard) recorded by the Swedish Kennel Club. In total 5877 and 5406 dogs examined for hip and elbow dysplasia, respectively, from January 2002 through March 2003 were included. We used logistic regression to examine whether the type of chemical restraint used for sedation affected the screening result for hip and elbow dysplasia. In addition to sedation method, the effects of veterinary clinic, sex, breed, and age at screening were studied.

The type of chemical restraint used for sedation affected the screening result for hip but not for elbow dysplasia. Acepromazine gave less than half the odds of hip dysplasia compared with medetomidine and butorphanol (the most common method), medetomidine alone or xylazine. Females had about 25% higher odds for developing hip dysplasia whereas males had almost 40% higher odds for developing elbow dysplasia. Saint Bernard, Newfoundland and German Shepherd Dog had the highest odds of developing hip dysplasia, whereas Rottweiler and Labrador Retriever had the lowest odds. Boxer had the lowest risk for elbow dysplasia, followed by Labrador Retriever. Saint Bernard and Rottweiler had the highest odds of elbow dysplasia. Increasing age increased the odds of both hip and elbow dysplasia, by about 2.5% per month.

Following the results in this study, recording of the type of chemical restraint used for sedation during hip screening has now become mandatory in Sweden. This makes it possible to account for the effect of sedation method in a model for prediction of breeding values for hip dysplasia.     

Radiographic evaluation of nonanesthetized and nonsedated dogs for hip dysplasia

The use of chemical or gas restraint was unnecessary in most large breed dogs being evaluated radiographically for hip dysplasia. Of 100 large-breed dogs, 97 were successfully radiographed for hip dysplasia evaluation without the use of sedation or anesthesia.     

Feasibility of computed tomography in awake dogs with traumatic pelvic fracture

In veterinary medicine, general anesthesia or sedation is generally required to immobilize patients during computed tomography (CT) scanning. This may not be suitable in all patients because of risks of anesthesia. We evaluated the feasibility of pelvic CT examination in 14 awake animals with pelvic trauma. Physical restraint was applied by wrapping the patient in a towel and then taping to the CT table or by directly taping the patient to the CT table. The effect of patient positioning, cooperation on the CT table, preparation time for scanning, scanning time, frequency of repeat scans, image quality, and complications related to physical restraint were evaluated. Fractures were recorded and compared between radiography and CT. Ten of 14 dogs were scanned in lateral recumbency and four in sternal recumbency. All patients were cooperative with the exception of one that moved slightly during the scan. Both physical restraint methods were adequate for CT scanning. Patient preparation took less than 5 min while the scan time was typically less than 1 min. No repeat scans were required in any patient. The transverse CT image quality was good (10/14) or fair (4/14) for interpretation. When comparing the CT images to radiographs, more pelvic fractures were identified with CT than with radiography and a few patients were overdiagnosed based on radiographs. No complications or additional injuries associated with physical restraint were noticed.     

The use of sedatives,analgesic and anaesthetic drugs in the horse: An electronic survey of members of the American Association of Equine Practitioners (AAEP)

Reasons for performing study: To determine the sedative, analgesic and anaesthetic drugs and techniques that are used by equine veterinarians. Hypothesis or objectives: To provide equine veterinarians with information concerning veterinary use of anaesthetic techniques, a reflection of the collective experiences of the profession. Methods: A survey was conducted of those members of the American Association of Equine Practitioners (AAEP) with an electronic mail address on file with the organisation using proprietary, web‐based software. The survey was comprised of 30 questions divided into 8 sections: nonsteroidal anti‐inflammatory drugs; local anaesthesia; alternative techniques; standing chemical restraint; epidural anaesthesia; short‐term anaesthesia; long‐term anaesthesia; and a place for the respondent to make comments. Results: The response rate was 13.8% (952/6911) AAEP member veterinarians primarily use phenylbutazone and flunixin as anti‐inflammatory drugs, and lidocaine and mepivacaine for local anaesthesia. Combinations of drugs are preferred for standing chemical restraint. While many veterinarians frequently utilise short‐term anaesthesia, longer anaesthesia is less frequently performed. Conclusions: Most AAEP member veterinarians use sedatives in combination to provide standing chemical restraint. Extra‐label use of drugs is a core component of current equine sedation and anaesthetic practice. Potential relevance: Equine veterinarians can compare their choices of anaesthetic drugs with others practising equine medicine and surgery and may be stimulated to investigate alternative methods of providing comfort to horses.     

EFFECTIVE SEDATION OF RABBITS, GUINEA PIGS, RATS AND MICE WITH A MIXTURE OF FENTANYL AND DROPERIDOL

SUMMARY A minimum effective dose rate for Innovar-vet^(R) was established for producing sedation of rabbits, guinea pigs, rats and mice. The level of sedation permitted a minimum of restraint and abolished painreactions. No special precautions were necessary and administration was by simple intra-muscular injection. Recovery occurred within 1–2 hours and was uneventful and without excitement. A single operator was able to carry out bleeding safely, and would be able to carry out other minor procedures with minimal stress to the animal.     

Sedation and chemical restraint of deer

This review examines the properties of chemical immobilising agents of use or potential use in deer for velvet antler removal. The alpha-2-adrenergic agonist, xylazine, is the most commonly used agent for chemical restraint of stags for this purpose in New Zealand. This compound is often combined with an opioid or ketamine to enhance its effectiveness. Concerns about the carcinogenic potential of a xylazine metabolite have led to a call by the deer industry to limit the use of this drug and stimulated enquiry into alternatives. The potent pure opioid agonists, fentanyl, carfentanil and etorphine, are less effective than xylazine when used alone, and their use presents greater risk to operators and animals and is subject to more stringent legal restrictions. Newer alpha-2-adrenergic agonists, detomidine and medetomidine, are more potent than xylazine and unlikely to result in carcinogenic metabolites. Availability of specific alpha-2-adrenergic antagonists further enhances the usefulness of these drugs. The dissociative agent, ketamine, has proven useful for immobilisation of various domestic and wildlife species and captive species of deer but undesirable side effects and the low concentration, relative to the effective dose, of currently available formulations limit its usefulness. Combination of a dissociative agent with an alpha-2-adrenergic agent reduces the required dose of both and enhances their efficacy. A commercially available combination of the dissociative anaesthetic agent, tiletamine, and the benzodiazepine, zolazepam, is more potent than ketamine and induction times are faster. This combination can be manipulated to varying concentrations by dissolution with alpha-2-adrenergic agents. A long-acting neuroleptic agent, zuclopenthixol, has recently been investigated for calming deer and may be an alternative to classical sedative-immobilising agents. Most chemical immobilisation agents used alone or in combination produce respiratory depression and supplemental oxygen has been recommended. All would likely result in some form of chemical residues in velvet antler.     

Results of the confidential enquiry into perioperative small animal fatalities regarding risk factors for anesthetic-related death in dogs

OBJECTIVE: To identify major risk factors associated with anesthetic-related death in dogs. DESIGN: Case-control study. ANIMALS: 148 dogs that died or were euthanized within 48 hours after undergoing anesthesia or sedation and for which anesthesia could not be reasonably excluded as a contributory factor (cases) and 487 control dogs that did not die within 48 hours after undergoing anesthesia or sedation (controls). PROCEDURES: Details of patient characteristics, preoperative evaluation and preparation, procedure, anesthetic and sedative agents used, monitoring, postoperative management, and personnel involved were recorded. Mixed-effects logistic regression modeling was used to identify factors associated with anesthetic-related death. RESULTS: An increase in physical status grade, urgency of the procedure, age, or intended duration of the procedure; a decrease in body weight; anesthesia for a major versus a minor procedure; and use of injectable agents for anesthetic induction and halothane for maintenance or use of inhalant anesthetics alone (compared with use of injectable agents for induction and isoflurane for maintenance) were associated with increased odds of anesthetic-related death. CONCLUSIONS AND CLINICAL RELEVANCE: The results suggested that specific factors could be associated with increased odds of anesthetic-related death in dogs. Knowledge of these factors should aid the preoperative assessment and perioperative management of dogs undergoing anesthesia and sedation.     

Chemical restraint by medetomidine and medetomidine–midazolam and its reversal by atipamezole in Japanese macaques (Macaca fuscata)

Objective To evaluate the sedative effects of medetomidine, and a medetomidine–midazolam combination, in Japanese macaques and the antagonism of medetomidine–midazolam with atipamezole. Study design Prospective randomized study. Animals Thirteen healthy Japanese macaques between 3 and 21 years old and weighing between 4.3 and 15.1 kg. Methods Medetomidine (120 µg kg^?1) alone or a medetomidine (30 µg kg^?1) plus midazolam (0.3 mg kg^?1) mixture were injected intramuscularly in the hind limb of 12 animals (n = 6 for each group) and their effects, particularly behavioural changes, response to external stimuli, sedative onset time, time to lateral recumbency and time in lateral recumbency, were monitored for 120 minutes. Another group (n = 7) were given medetomidine–midazolam and injected 30 minutes later with atipamezole (120 µg kg^?1). Behavioural changes and responses to external stimuli were assessed as before. Results Animals given medetomidine became sedated but could be aroused by external stimuli. Despite the lower (25%) dose of medetomidine involved, the effects of medetomidine–midazolam were more marked. Macaques given this combination became sedated in 4 ± 2 minutes (mean ± SD) and remained unresponsive to external stimuli for at least 60 minutes. Five out of six macaques became laterally recumbent for 74 ± 37 minutes. Intramuscular atipamezole effectively reversed sedation, shortening the arousal and total recovery time. The recovery from sedation was rapid and smooth, being completed 19 ± 11 minutes after antagonism. Conclusions The medetomidine–midazolam combination described provided useful chemical restraint and may prove useful in macaques undergoing some experimental, diagnostic or therapeutic procedures. The use of atipamezole as an antagonist increases the value of this technique in macaques.