Page 2926 - Cote clinical veterinary advisor dogs and cats 4th

Sedation and Chemical Restraint in Small Animal Practice
Keith Branson, DVM, MS

Disclaimer: The following drugs and applications are recommended based on published reports and clinical experience. Specific use must be guided
by appropriate and reasonable precautions, preparation, and information on the part of the veterinarian using or advocating the use of these prod-
VetBooks.ir Acepromazine
ucts. Descriptions of drug effects and parameters of usage are likely to vary from one patient to the next, and the description of the drug character-
istics listed here applies to patients that are otherwise healthy.

Expected observable effect: tranquilization, ± hypotension. With encouragement, Advantages: substantial, effective sedation/mental depression; effect is often
the animal should still be able to rise and walk but with obvious mental depression. prolonged
Dosage and route (dog or cat): 0.025-0.05 mg/kg IV or 0.05-0.15 mg/kg IM Drawbacks: no analgesia, no antianxiety effects; highly variable/unpredictable
or SQ (oral tablet dosage is 5-10 times higher) duration and intensity of effect, especially in older or systemically ill patients.
Pain control: none Rare manic/hyperaggressive reactions
Time to desired effect of sedation: 2-3 minutes (IV), 5-15 minutes (IM or SQ), Expected duration of effect/recovery: 30 minutes to several hours
10-20 minutes (oral) Alternative: for milder sedation: butorphanol + either diazepam or midazolam
Indications: tranquilization of otherwise healthy, young- to middle-aged dogs (e.g., healthy but older dog or cat)—see below
and cats Notes and comments: seizure threshold-lowering effects are unproven
Contraindications (relative): old age; hypotension; most heart, liver, or kidney
diseases and other disorders in which arterial hypoperfusion could be deleterious
Butorphanol + Acepromazine
Expected observable effect: mild to moderate sedation. Does not cause immo- Advantages: prolonged sustained sedation; flexibility of IM or IV route
bilization, but prolongs the duration and degree of tolerance to restraint Drawbacks: prolonged recovery period and interindividual variability of effect,
Dosage and route (dog or cat): butorphanol 0.1-0.5 mg/kg IV or IM + aceproma- especially when combined with acepromazine
zine 0.025-0.05 mg/kg IV or IM. Butorphanol and acepromazine can be Expected duration of effect/recovery: 20-30 minutes (IV use), variable up to hours
mixed in the same syringe for immediate use. (IM route when combined with acepromazine)
Pain control: mild Alternatives: for slightly greater sedation butorphanol + diazepam/midazolam
Time to desired effect of sedation: < 1 minute (IV) or 10-15 minutes (IM) (e.g., healthy but older dog or cat)—see below. For greater sedation: add
Indications: sedation and immobilization for minimally painful procedures. acepromazine 0.025-0.05 mg/kg IV or 0.05-0.15 mg/kg IM (e.g., healthy young
Useful for very active or agitated young animals dog or cat).
Contraindications: older animals (relative contraindication to acepromazine); Notes and comments: butorphanol + acepromazine 0.05 mg/kg + glycopyrrolate
hypovolemia, dehydration, hypotension, most heart diseases, marked acid-base 0.01 mg/kg are commonly added together to create a preanesthetic combination
imbalance, or other instances of systemic illness (“B-A-G”) for healthy dogs and cats. Reduce dose for dogs with MDR1/ABCB1-Δ.
Buprenorphine
Expected observable effect: prolonged mild to moderate sedation; the animal may Expected duration of effect/recovery: up to 6-8 hours with higher dosage of
be roused with stimulation, but quickly reverts to being quiet and less responsive buprenorphine combined with acepromazine, IM
Dosage and route (dog or cat): 0.005-0.02 mg/kg IV or IM. Alternatively, Alternatives: for greater sedation (e.g., diagnostic imaging in a very agitated but
0.01 mg/kg sublingually (transmucosal absorption) is possible in cats. stable puppy), add acepromazine 0.02-0.05 mg/kg (IM or IV)
Pain control: mild to moderate Combinations: can be combined with dexmedetomidine (0.005-0.01 mg/kg) as
Time to desired effect of sedation: 15-30 minutes (longer to achieve peak anal- a premedication or heavy sedation protocol
gesic effects). Clinical sedation may be apparent sooner when buprenorphine Notes and comments: this is a long-acting opioid and its effects are not easily
is combined with other sedatives/tranquilizers. reversed with naloxone. Buprenorphine is used frequently for postoperative
Indications: sedation and immobilization for minimally painful procedures. analgesia due to the prolonged dosing interval that is required. A once-a-day
Useful for very active or agitated young animals formulation is available (Simbadol). The time to onset for Simbadol is com-
Contraindications: older animals (relative contraindication); hypovolemia, de- parable to the conventional product.
hydration, hypotension, most severe heart diseases, marked acid-base imbal-
ance, or other instances of systemic illness
Butorphanol + Diazepam (or Butorphanol + Midazolam)
Expected observable effect: the animal becomes quieter but remains responsive Advantages: provides light sedation
to sound and is less likely to react to mild noxious stimuli or to struggle dur- Drawbacks: IV administration (diazepam); short duration of action
ing manual restraint. Expected duration of effect/recovery: animals that are otherwise healthy gener-
Dosage and route (dog or cat): butorphanol 0.1-0.5 mg/kg IV or IM + either ally remain able to ambulate with this protocol or regain the ability to do so
diazepam 0.1-0.2 mg/kg IV or midazolam 0.1-0.2 mg/mg IV or IM. Avoid within 15-20 minutes of administration (IV use).
combining other drugs in the same syringe with diazepam due to propylene Alternatives: for greater sedation, omit diazepam/midazolam and replace with
glycol in diazepam’s formulation. dexmedetomidine 0.005 mg/kg IM or IV, or omit butorphanol and replace
Pain control: mild. with hydromorphone 0.1-0.2 mg/kg IM or IV, or add acepromazine
Time to desired effect of sedation: <1 minute (IV) or 5-15 minutes (IM) 0.025-0.05 mg/kg IM or IV.
Indications: mild sedation and analgesia (e.g., ultrasound exam or radiographs Notes and comments: midazolam historically was expensive but is now available
of very restless young animal or of mildly fractious cat) as generic (cost is similar to diazepam). Midazolam is better tolerated for IM
Contraindications: liver disease (diazepam, midazolam); hypovolemia, dehydra- injection and the absorption is less variable.
tion, marked acid-base imbalance, or other instances of severe systemic illness

Hydromorphone
Expected observable effect: mild to moderate sedation. Generally, the animal still Drawbacks: nausea, panting, increases vagal tone (causing bradycardia). When
will be able to walk. Hyperresponsiveness to sound is common (avoid loud noises). used in cats, it may cause hyperthermia and excitement if used alone.
Dosage and route (dog or cat): 0.05-0.2 mg/kg IV or IM Expected duration of effect/recovery: sedative effects typically are longer than
Pain control: moderate butorphanol. Animals regain the ability to walk within 30 minutes of admin-
Time to desired effect of sedation: 1-2 minutes (IV) or 5-15 minutes (IM) istration. Repeated dosing for analgesia is q 4-6h.
Indications: analgesia and sedation (mild or moderate) Alternatives: for greater sedation, add diazepam/midazolam (see below) or
Contraindications: vomiting/nauseated patient; noisy environment; hypovole- acepromazine (see above).
mia, dehydration, marked acid-base imbalance, or other instances of severe Notes and comments: emetic effects appear less pronounced in painful animals
systemic illness when administered IV.
Advantages: minimal cardiovascular depression; analgesic properties Reversal: can be revsersed with naloxone