Trazadone and methadone pre anaesthesia?

RE: Trazadone and methadone pre anaesthesia?

Helena Rymaszewska — Thu, 10 Feb 2022 17:10:13 GMT

absolutely.

A couple of referral centres have told us they now screen all dogs coming from Europe, for brucella.....

RE: Trazadone and methadone pre anaesthesia?

Sarah Keir — Wed, 09 Feb 2022 16:53:42 GMT

Entire dog from Romania - has it been screened for Brucella?

RE: Trazadone and methadone pre anaesthesia?

Michael Woodhouse — Mon, 07 Feb 2022 23:38:44 GMT

[quote userid="9179" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235739#235739"]I'm a little concerned at how much I find myself using these drugs these days - I don't think it's a benevolent thing, rather reactionary to more challenging dogs.[/quote]

Is it just me who finds doing procedures with 'challenging' dogs vastly more satisfying? A placid Border terrier or calm Lab don't really do it for me.

(have gabapentin but never used trazodone. Personally HATE methadone as part of a pre-med, but I appear to be on my own. Crappy anaesthetics cf butorphanol.)

RE: Trazadone and methadone pre anaesthesia?

Chris Milligan — Mon, 07 Feb 2022 22:54:44 GMT

We've been dishing out trazodone and gabapentin way more thanks to pandemic puppy syndrome of anxiety and poor socialisation. A little skewed in that we tend to be giving it to really difficult dogs, but in my experience it seems to allow an untouchable dog to become somewhat touchable. I'm not sure the role of the trazodone tbh - I tend to give high doses of gabapentin and it seems these patients just have signs of this alone despite the trazodone. Each to their own.

I'm a little concerned at how much I find myself using these drugs these days - I don't think it's a benevolent thing, rather reactionary to more challenging dogs.

RE: Trazadone and methadone pre anaesthesia?

Jennifer Whybrow — Sat, 05 Feb 2022 22:23:12 GMT

Midazalam and fentanyl isn't Midazalam.. I can agree ré fentanyl being a pleasant experience. Interesting you got both for that procedure.

RE: Trazadone and methadone pre anaesthesia?

Martin Hamilton — Sat, 05 Feb 2022 14:56:19 GMT

I'm glad things went well for you, the dog, and the owner Janine. Thank you for presenting the case and generating some good discussion.

RE: Trazadone and methadone pre anaesthesia?

janine redman — Sat, 05 Feb 2022 14:54:27 GMT

Update on this dog .

The combination worked very well and once away from her somewhat ineffectual owner the anaesthetic and post anaesthetic period was stress less and peaceful .she was good to handle , even putting a post op vest on and replacing her harness

RE: Trazadone and methadone pre anaesthesia?

Stephen Courtney — Sat, 05 Feb 2022 13:28:46 GMT

We have found trazodone and gabapentin extremely helpful handling nervous dogs that need things doing to them, especially surgery, but also simple things like vaccinations, ear treatments etc. We are seeing more and more dogs that are very hard to do anything with - the train wrecks from Romania, but also the poorly socialised pandemic cockerpoo types that seem to be increasing in number exponentially. Usually owned by folk with no previous experience of dogs .

Traz and Gabapentin don't affect routine pre med doses, we usually use methadone and medetomidine, also use a fair amount of co-induction for older animals

I think it's a mistake to transpose your own experiences with medication into our work - midazolam is not a horrible drug, just a drug...when I had IV fentanyl and midazolam for a rear entry scoping session it was actually very nice indeed....having said that, I prefer not to take things if I can, alchohol excepted, we all rect differently to things, our patients are no exception.

Taking the fear away is certainly helpful preventing the phobic spin up developing

Dog catchers and door trapping in this day and age? Not worth the hassle, it freaks the nurses out , and god help the next vet who goes near that dog ... if the results of trazodone aren't good enough I rebook on higher does and add in gabapentin. Sileo can be used on arrival at the clinic to improve the overall results, but its almost useless on its own

RE: Trazadone and methadone pre anaesthesia?

Clive Ansell — Sat, 05 Feb 2022 10:53:11 GMT

[quote userid="16672" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235706#235706"]But if you could justify that using trazodone/gabapentin meant you could use lower doses of anaesthetic drugs, increasing safety of GA, would that be a valid enough excuse under the cascade (as part of a multimodal anaesthetic protocol)?[/quote]

Different vets seem to interpret the cascade rules in different ways, poorly drafted and vague legislation. Grey area.

I would say yes, but really the answer to the above would depend on what other suitable licenced alternatives are available to achieve the same thing, for example in an already relaxed and calm dog, licenced Medetomidine and Methadone would provide a good premed and lower the doses of anaesthetic drugs required.

RE: Trazadone and methadone pre anaesthesia?

Glenn Hodgson — Sat, 05 Feb 2022 08:56:19 GMT

Trazadone. Have used this many a time. Do not change the premed. Anecdotally certainly seems to help.

Selio. I have used this once pre-procedure. I think I also prescribed some tephine (Buprenorphine) tablets prior to the journey too. Full sedative dose in the boot outside (Admin by client and RVN close by). This resulted in a happy relaxed dog being carried in.

Compered to other techniques, lead through door and hold on tight, 3 people large with gloves, ketamine into mouth as barks through kennel......... Pre-sedation of some type has to be both safer and better for these patients.

RE: Trazadone and methadone pre anaesthesia?

Martin Hamilton — Fri, 04 Feb 2022 20:35:24 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235690#235690"]I would be uneasy, with regard to the cascade rules, about using gabapentin and trazadone as a routine in all dogs as Martin suggests. If they likley to be difficult, nervous or aggresive thats different, and I think to comply with the cascade their use would have to be decided on a case by case basis.[/quote]

Firstly, we don't use both in every dog, usually just trazodone, however if they already had some on board for the consult and they're still fear aggressive/difficult to handle then we add gabapentin.

Secondly, we don't have a cascade system here so it's not a concern. Generics for everyone! Not sure how it would play out back home, as you say you'd probably have to be more selective for that reason alone.

But if you could justify that using trazodone/gabapentin meant you could use lower doses of anaesthetic drugs, increasing safety of GA, would that be a valid enough excuse under the cascade (as part of a multimodal anaesthetic protocol)? Anecdotally, and looking at hospital numbers, we have great anaesthetic outcomes - of course that is likely due to us utilising an anaesthesiologist, but I'm sure that the pre-op drug protocol that they introduced is one of many favourable factors.

Some owners report that pets are "high" or "spaced out" post-op, but that can be secondary to any number of the drugs we use (ketamine, but more likely opioids etc), so not necessarily something that can be pinned down to just traz/gaba. If the owner has administered either of these drugs in the past and there were any adverse effects then we will, of course, not recommend them. Have to treat every animal as the individual that they are.

RE: Trazadone and methadone pre anaesthesia?

Jennifer Whybrow — Fri, 04 Feb 2022 13:03:02 GMT

Midazalam.is à horrible drug.... personal experience again.. Think it will get banned for people at some point because of how it affects judgement and for quite a while after it's given which they don't warn you about. I think it's contraindicated in cases of ptsd but you'd need to check up on that as I can't recall where I got that from.

There's a difference imo between a traumatised creature and one that's simply nervous. And also the way they've been trained will likely affect how they respond to mind altering substances because of the context of the brain that it's being asked to work in, hippocampal, amygdala etc. Just my thoughts as they are currently, and now I'm ducking and running for cover

RE: Trazadone and methadone pre anaesthesia?

Jennifer Whybrow — Fri, 04 Feb 2022 13:01:31 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235689#235689"]except the owners have to get the Sileo into the right place in the mouth[/quote]

Maybe they could practice with peanut butter? Would it be helpful to have some videos with approximations and demonstrations on a nervous dog? If so I'll ask around and see if anyone has any.

Weird soh alert. I've been working on desensitising to syringes but now I have a dog that's wary of syringe at side of mouth who thinks she needs to have it go up her nostril!

So if the owner can handle the dog and has a great 'trust account' that could be a really useful way forward.

If it works well for noise phobia that's really useful info and my guess is its doing something therapeutic rather than just banging you out at all levels.

RE: Trazadone and methadone pre anaesthesia?

Jennifer Whybrow — Fri, 04 Feb 2022 10:17:29 GMT

Interested to see a dog on trazadone 'freezing' when Elizabethan collar hits the wall (at home). Any ideas why this could be happening.. I thought trazadone was supposed to prevent that.. I think dog is in usa but haven't checked just was curious as freeze is potentially indicator of everything not being calmed in the dog.

RE: Trazadone and methadone pre anaesthesia?

Clive Ansell — Fri, 04 Feb 2022 08:39:56 GMT

[quote userid="12533" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235688#235688"]How do people see the cascade working in these situations?[/quote]

I don't see any issues with the cascade at all.

Although gabapentin and trazadone are not licenced, it is a good, and well recognised and accepted form of therapy for helping to calm aggressive or nervous dogs. Given that no licenced versions exist, their use is perfectly acceptable within the cascade regs.

I have tried Sileo, but found it less reliable albeit based on a small number of cases. Therefore based on experience I can justify the use of gabapentin and trazadone over Sileo, so I am within the cascade regs.

I would be uneasy, with regard to the cascade rules, about using gabapentin and trazadone as a routine in all dogs as Martin suggests. If they likley to be difficult, nervous or aggresive thats different, and I think to comply with the cascade their use would have to be decided on a case by case basis.

This conversation crops a lot in relation to the feline quad combination anaesthetic, containing Midazolam. Some practices won't use it because of the cascade, but again it is a well recognised protocol that is safe and works well, so can be justified clinically and within the cascade regs(In my opinion).

RE: Trazadone and methadone pre anaesthesia?

janine redman — Fri, 04 Feb 2022 08:37:31 GMT

That would work except the owners have to get the Sileo into the right place in the mouth . It works well for my noise phobic collie and does work as a nice premed

RE: Trazadone and methadone pre anaesthesia?

Catherine Churchill — Fri, 04 Feb 2022 08:06:02 GMT

Have wondered myself about using sileo (dexmedatomadine) for these nervous dogs , can be given at home before the dogs come in and the added advantage is it is a licenced product, although for noise phobia. How do people see the cascade working in these situations?

RE: Trazadone and methadone pre anaesthesia?

David Mills — Wed, 02 Feb 2022 22:02:14 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235535#235535"]

Why?

I guess it could easily be argued that it makes every dog a little easier to handle, but is an example (sorry Martin) of an American way of doing things. Anyone boarded in the USA seems to have reverence in that everything they do is right and if you divert you are wrong, when in reality it's a bit more nuanced in this country thank goodness. Read any USA based clinical discussion thread and this view pertains. As I put recently it's easy to rack up the things to do, it's more difficult to justify a thoughtful approach and dial it down.

Neil

[/quote]

Is Neil becoming a little Brexiteer?

Do they still give atropine as a pre-med in the US?

As to OP, I wouldn't change anything but oral sedatives IME aren't great unless hugely dosed (e.g. 100mg gaba to a cat) and I rarely bother, doors, dog catcher etc if required.

Dog sounds like a nightmare and the fact it wasn't neutered before rehoming with those issues sadly an all-too-common scenario in these foreign "rescues" (read profit wagons) which hopefully can be outlawed pretty soon. Not helpful clinically, but still.

RE: Trazadone and methadone pre anaesthesia?

Jennifer Whybrow — Wed, 02 Feb 2022 21:49:23 GMT

Do you know if its had a good effect once whether that would be indicator of being good a second time. I know with ACP people used to get good or awful responses. And do you have any experience of it being given orally, like in people? As a premed.

[quote userid="4367" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235617#235617"]It's fine as part fo the induction to reduce propofol/afax[/quote]

RE: Trazadone and methadone pre anaesthesia?

Iain Richards — Wed, 02 Feb 2022 18:40:06 GMT

[quote userid="17944" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235542#235542"]Our vet in Cairo gave diazepam and that worked really well on our dog. I[/quote]

Lucky you. Benzodiazepines in dogs can remove inhibition and lead to some nasty experiences. It's fine as part fo the induction to reduce propofol/afax

RE: Trazadone and methadone pre anaesthesia?

Jennifer Whybrow — Wed, 02 Feb 2022 11:32:57 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235570#235570"]powerful very short acting opioid, [/quote]

Was it fentanyl? I only had a knee op.. I woke up pain free and scared everyone by jumping out of bed running around because of being pain free, then I was sick out of the car window on the drive home and spent another 24 hours feeling like I was coming in and out of consciousness. They took me back in for 24 hours to sleep it off.

For a gut thing they just used midazalam, I was totally aware and it was interesting seeing the gut on the screen but nit surreal however the drug affected my judgement fir about a week which extended as I recall to some paintball voucher purchases.

Last time I had anaesthesia they gave dex as well at induction and I asked them to take extra care with keeping me warm, and it was better but no explanation has ever been given on why it takes me so long to wake up from these drugs. Also sensitive to alcohol,not sure if that's relevant.

Old style anaesthetic with premed used to feel bit nauseous then induction smooth but no sense of anything other than going to sleep in a nice way and waking up. was easy, less abrupt but once awake was back to normal consciousness straight away

Please don't suggest I have a brain tumour, my mother's route of death but otherwise really useful if there's any ideas.

With covid my temperature went low not high too.

With having such bad experiences with drugs that were meant to help me and with my friends brother dying in mental institution and Oliver McGowan I just am very concerned that more passive behaviour might not be being read correctly in every case and I feel very vulnerable sharing this but I think it needs for it to be considered.

I'm also sensitive to pet remedy diffuser, if it's just dt bbb damage which has never been suggested as being something I have fair enough, but if it's an inherent quality of the drugs themselves then I have concerns. I couldn't tolerate gabapentin but from those who have taken it I hear given the same choice they wouldn't have done.

I think people have different cultures... I know they do. As a youngster going to Greece to stay with my penfriend I was told I should not smile and avert my gaze. This was incredibly difficult for me to do. I'm not suggesting this is a factor here between vet and dog but I've been thinking about my own dog and the behavioural advice were given to examine dogs on the floor etc. Some dogs might feel safer high for example.

There is a behaviourist Debby Busby who I've had some conversations with and I know has an interest in street dogs.. She might be a good port of call. I feel for these owners as its extremely difficult to manage to explain to folks what my dog needs from them to feel safe, ie to be totally ignored, very much like a cat in that respect.. Any eye contact from strangers is hard too.

Chirag Patel donesticated manners has a "game" called the bucket game which seems to help. I've shared it with a dog I'm trying to help the owner of and she feels it has helped him. So that is something that can help but if the owner can handle him well and it's just strangers she's scared of that is very positive.

I'm watching a course of behaviour talks at the moment and there was a good one on snake avoidance. One thing that the owner might consider is using an aroma as a safety cue. Pet remedy spray is tiny and fits in a pocket. I feel for you as you don't have time to ds and cc, but another top I've been given is to make the antecedents as different as possible for the dog if something has to be done without their consent.

It's probably pretty stupid to try to address any bh in a thread but the new approaches do have promise.

Another thing I've noticed is that the dog will offer a chin rest perhaps, something I've never been taught. If I want to speak to a German person it's easier sometimes to speak German. I also greet differently.

I hope the spay goes well.

Our Cairo vet gave Valium as a pre blood sampling drug and it worked brilliantly. I've had it as premed in the past and though I felt nauseous that was with the anaesthetic I did get on with which were also given when I was younger.

Hopefully this answer is a bit more helpful.

I am amazed how much metacam has made a difference which us stupid if ne because fentanyl made a difference to me. It was awesome to have no pain. One forgets hiw much chronic pain affects brain function and muscle tension.

RE: Trazadone and methadone pre anaesthesia?

Clive Ansell — Wed, 02 Feb 2022 07:25:55 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235567#235567"]It would be extremely difficult to know if this dog is in pain[/quote]

I guess you could have a good look and feel of limbs etc when she's under GA for a spey, plus radiographs if any suspicion of spinal or limb pain.

otherwise an analgesia trial period maybe?

RE: Trazadone and methadone pre anaesthesia?

Clive Ansell — Wed, 02 Feb 2022 07:23:05 GMT

[quote userid="9440" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia"]I have a 37kg ex Romanian rescue that is higHly anxious and terrified of being handled .[/quote]

One has to question whether it is right and fair to import such a dog, and whether pts would be kinder?

Maybe a behaviourist? going to need some work and commitment from a dedicated owner.

RE: Trazadone and methadone pre anaesthesia?

Clive Ansell — Wed, 02 Feb 2022 07:19:13 GMT

[quote userid="17944" url="~/001/veterinary-clinical/small-animal/anaesthesia/f/discussions/30175/trazadone-and-methadone-pre-anaesthesia/235541#235541"]I don't like the newer anaesthetics they're using in people. I preferred the older protocols. They were much easier to wake up from and didn't leave you feeling hung over for several days. I liked propofol until I was given it myself. [/quote]

I had a brilliant anaesthetic last June. A powerful very short acting opioid, which I forget he name of, and propofol, plus an anti-emetic. Brilliant, no side or hangover effects other than being ravenously hungry on recovery. Really good use of local analgesia too. I had a spinal op, and on recovery I remember asking why it hadn't been done as I was totally pain free!

RE: Trazadone and methadone pre anaesthesia?

janine redman — Tue, 01 Feb 2022 23:25:37 GMT

It would be extremely difficult to know if this dog is in pain , she certainly doesn’t behave as if she is at home. She is fine with dogs but still terrified anf people and whilst she will tolerate gentle stroking she would not tolerate examination or any form of restraint. Probably due to poor genetics and lack of early socialisation and handling. She copes with her owner but not when around unfamiliar people