Sedation Techniques for Rasping

Re: Sedation Techniques for Rasping

Michael Woodhouse — Wed, 16 Apr 2014 19:25:47 GMT

I wonder what a bit of ketamine might bring to the party - after the initial sedation.

Re: Sedation Techniques for Rasping

cequi — Wed, 16 Apr 2014 19:20:20 GMT

Can report, the diazepam made no difference. The patient was a chunky 650kg Trakehner who shakes his head a lot, and adding 10mg diazepam about 15 mins after the initial alpha-2 + butorphanol made no difference at all. Only topping him up to the eyeballs with alpha-2 + butorphanol did...

Re: Sedation Techniques for Rasping

cequi — Wed, 09 Apr 2014 16:32:02 GMT

Thanks for the replies. Adding ACP to the combo is a classic mix, and I've honestly not noticed much of a difference with or without it, so stopped using it. Sedivet (Romifidine) we can't get that easily here in Austria (only by parallel import, and I couldn't be bothered with the paper work ...yet?). So I might still try the diazepam at least once and let you know how I got on, if you like.

Re: Sedation Techniques for Rasping

Evelyn Barbour-Hill — Wed, 09 Apr 2014 11:54:55 GMT

After asking around..... I don't think diazepam will specially help with your Trakehner.

Other suggestions received........ ACP pre-sedative? Use morphine rather than Torbugesic?

Re: Sedation Techniques for Rasping

Wren — Wed, 09 Apr 2014 08:44:25 GMT

[quote user="Evelyn Barbour-Hill"]

2 or 3 ml of the 5mg/ml solution. That's the bottom end of the generally quoted dose range, which I guess is what one wants. I'm not an anaesthesia expert,

[/quote]

Me neither, but my dose for a big horse would be somewhere between one and two vials which is 10-20mg, so pretty much the same as you. I'm using less diazepam these days. Have stopped using it for my GA for knock down castrations and haven't really noticed a difference. I now just use sed/torb followed by a bolus of ketamine. I pretty much only use it for foals now, though it may be of help in the above horse.

Although they 'should' work similarly there are definitely some horses which sedate better with Sedivet or Domosedan. My preference is Sedivet, but I have a bottle of Domo in the car for those horses who prefer it.

Sadly there is no magic. I would suggest making sure external factors are in your favour. Normally I inject then pretty much put the gag on and get going, but with a difficult one I would inject the horse then leave it standing quietly for 10-15mins, preferably with the door shut and the lights off. External stimuli play a huge role - how often have you had a half sedated horse messing around which goes to sleep properly as soon as you have finished messing about with it?

Re: Sedation Techniques for Rasping

Michael Woodhouse — Wed, 09 Apr 2014 00:00:26 GMT

I stand by what I said 2 years ago - make sure you give a decent dose of sedative in the first place. Sedivet is licensed up to 1.2ml/100kg. I will often use 1ml/100kg as a standard for castration, clipping or teeth.

I don't do many teeth so like them co-operative.

Re: Sedation Techniques for Rasping

Evelyn Barbour-Hill — Tue, 08 Apr 2014 23:49:53 GMT

[quote user="cequi"]

Hi Evelyn,

"Option 2 ... Domosedan and Torbugesic ... and then give a little bit of diazepam as well." How much is a little bit of diazepam in this context, say for a 500kg averagely lean horse? I have a very highly strung Trakehner to do shortly, who is notoriously difficult to keep settled during his dental and I'm looking for that little bit of "extra magic".

Thanks! C

[/quote]

2 or 3 ml of the 5mg/ml solution. That's the bottom end of the generally quoted dose range, which I guess is what one wants. I'm not an anaesthesia expert, this is just what I was taught. I must say, the main benefit is in a bit of muscle relaxation which helps if the tongue keeps getting in your way for instance. Whether it will give you your bit of magic I don't know.

I'll ask around.

It would be great if any anaesthetist persons out there could give us a comment.

Re: Sedation Techniques for Rasping

cequi — Tue, 08 Apr 2014 20:45:11 GMT

Hi Evelyn,

Thanks! C

Re: Sedation Techniques for Rasping

Lwyalep - — Wed, 05 Oct 2011 15:07:56 GMT

thank you Gillian!! I hadnt even realised I still had it as 4th year! HA how cocky must I have sounded then?!

Re: Sedation Techniques for Rasping

Gillian Mostyn — Wed, 05 Oct 2011 13:45:44 GMT

[quote user="lucy penrose"]If he doesnt like rasping, a number of horses I have seen done or done myself[/quote]

Lucy - you may want to change your profile from being a 4th vet student to being a fully fledged VS - you've earned it!

Re: Sedation Techniques for Rasping

Wren — Tue, 04 Oct 2011 10:23:03 GMT

[quote user="lucy penrose"]

What about possibly giving the owner Domosedan gel to give prior to you arriving, then hopefully this will have had time to kick in by the time you get there in a non stressful way and so the sedation may be better?

[/quote]

The owner might be much better to deal with after a big dose of Domsedan

I've never had to knock one down for dental work and routinely use sedivet/torb. For a 600kg horse I'd go in with 3-3.5ml sedivet/1-1.5ml torb and have never had one fall over yet (touch wood!). The bad ones get 1-1.5ml ACP added to the cocktail - this doesn't seem to deepen the level of sedation but makes it last a little longer and seems to stop the 'snapping out of it' that you describe.

The most sedivet/torb I've had to use was 5ml/2ml for a 500kg-ish TB hunter to clip it. We got to this dose over a few sessions by trial and error and then used it 3-4x a year for the rest of the horse's life. They tied a jumper over its eyes before I got out of the car, popped a twitch on then I gave the drugs IV very quickly as it was as bad to inject as it was to clip. Done like this it was a pussy cat!

If none of the other suggestions work then you'll have to GA it (I use the protocols suggested above) but this is obviously a concern if it becomes a twice yearly occurence for the rest of its life. We recently had to PTS a horse which had to be GA'd to have its feet trimmed as they need doing every couple of months and the cost and stress of doing it 6x yearly for potentially the next 10 years wasn't something the owners were prepared to put up with. They had tried everything else before we got to the GA point anyway.

Re: Sedation Techniques for Rasping

Lwyalep - — Mon, 03 Oct 2011 11:30:06 GMT

I also agree that if he is that resistant against any thing in his mouth there is likely to be something quite painful going on so a thorough exam is going to be required so if no sedation method is working then maybe a GA is the only way to do the job that is required.....

If he doesnt like rasping, a number of horses I have seen done or done myself, that don't like hand rasps will tolerate dremels/power tools much better as there is not the "pull" so to speak, on the teeth that may be painful and so settle down and remain sedated better/for longer....

I hope you manage to figure it out.

Re: Sedation Techniques for Rasping

Fiona French — Sat, 01 Oct 2011 20:11:05 GMT

I have always found Domosedan much more reliable for sedation than Sedivet; for a horse that size I would start with 0.5ml each of Domosedan and Torbugesic, stay away from the horse to give it a chance to work, and if not enough consider topping up with a further 0.2ml of each, then possibly another if still not enough. If still unable to do anything, you can then always proceed to a field GA.

I would place an IV catheter at this point. The horse needs to be sedated enough to stand with head down and not react if you tap a knuckle on it's forehead, then you can knock down with ketamine 2.2mg/kg. This should give you about 20 minutes of anaesthesia, but you can top up with 1/3 to 1/2 of the induction dose of ketamine if required. You will also need to top up on domo after about 40 minutes, probably about 0.3ml. It is very difficult to judge depth of GA with these drugs though, and the best indicator seems to be feeling the strap muscles on the ventral neck, if they go tense it is probably about to sit up! During recovery, try to keep the horse down for as long as possible so it doesn't try to get up when still wobbly. Kneel just behind the ears and lift the muzzle up until it is about about to fling you off.

I am no expert, but this has always worked for me. Others may have different experiences.

Good luck!

Re: Sedation Techniques for Rasping

Evelyn Barbour-Hill — Fri, 30 Sep 2011 00:12:10 GMT

Of course, one reason for him reacting like that would be that there really is, unsuspected, something horribly painful in there. I guess that's a point in favour of going for the GA so that you can be sure of inspecting and examining properly.

Re: Sedation Techniques for Rasping

Evelyn Barbour-Hill — Thu, 29 Sep 2011 23:58:50 GMT

[quote user="Martin Jones"]Do you not have any horse 'dentists' out your way? Round here, they seem to manage the most fractious horses without sedation and with total ease. [/quote]

You had me there for a moment! Of course, for three hundred quid in cash in advance, miracles can be worked..............

Victoria, you seem to have two - no, three - options. What is the reason for the dental attention? Because option 1 is to abandon it and do nothing.

Option 2 is the Texas sedative with Domosedan and Torbugesic on the lines already suggested. It might help if you wait till sedation is complete and then give a little bit of diazepam as well. Having said that, there is the occasional horse who breaks out of it however much sedative you've given.

Option 3 is the field GA by your preferred method ()

On the whole I'd go for trying option 2 and then resorting to option 3 if it fails ('cos that's me). But your choice depends on many things: personal preference, owner attitude, availability of assistance and the reason for doing the procedure. (Is there clearly something nasty and painful in there? Is it just a routine precautionary rasp? Does the owner want something weird doing?)

Obviously if you're doing the teeth, you want to do them properly, but I'm afraid I can't agree that "a good going over" will lengthen the interval before attention is necessary again. Sorry.

Re: Sedation Techniques for Rasping

Mark Rowland — Thu, 29 Sep 2011 21:35:59 GMT

[quote user="Hannah Wynne Richards"]

Field GA far safer than overdosing with alpha 2s

Wynne

[/quote]

Not always. I went out one Sunday to a horse that had had field anaesthesia for a pus in the foot. Apparently it was in such pain that it required a GA. On waking it had such a panic reaction that it smashed its muzzle onto the ground breaking 2 of its front teeth... a real bloody mess. Hardly a good result if a dental had been done.

Re: Sedation Techniques for Rasping

Martin Jones — Thu, 29 Sep 2011 13:47:34 GMT

Viky,

Do you not have any horse 'dentists' out your way? Round here, they seem to manage the most fractious horses without sedation and with total ease.

Given the relative ease of procurement of ACP, and its total unreliability as either an anxiolytic or sedative, particularly when used in isolation, I'd wonder if your patient has already been through the 'dentist' route. I've heard countless tales of 'dentists' giving a bit of paste, only to find it ineffective, so giving it a bit more, and so on until the inevitable collapse. Just a thought.

I'd give the domo a go, but at a decent dose; if that doesn't work, then GA - unless owner is currently kicking up, in which case I'd go straight for the GA. Which, depending on what you're using, can be of indefinite length or suitable for topping up.

Can you imagine if we tried to do SA dental work without at least profound sedation? Why should it be any different for some horses?

Re: Sedation Techniques for Rasping

Hannah Wynne Richards — Thu, 29 Sep 2011 13:34:22 GMT

Field GA far safer than overdosing with alpha 2s

Wynne

Re: Sedation Techniques for Rasping

bob lehner — Thu, 29 Sep 2011 10:24:39 GMT

If he's really that difficult I would definitely go for a field ga - very much safer all round and you will be able to look at the mouth far better and do a proper job with the teeth.

I remember years ago I dealt with a gelding who needed his sheath cleaned out thoroughly on a regular basis, as it used to get really disgusting - but he was so sensitive around that area that it just could not be done safely with any sedative combo - he would try and kick your head off even when virtually falling over under sedation. I used to knock him over in the manege every so often and do the job properly. Apart from a bit of extra cost re the iv ga drugs there was no problem at all and I did it numerous times.

Hopefully if you give his teeth a really good going over they won't need to be done again for a good while.

Re: Sedation Techniques for Rasping

Michael Woodhouse — Thu, 29 Sep 2011 10:11:03 GMT

Under-dosing is pointless! For this sort of thing I give horses 1ml/100kg IV and 0.1ml/100 torb. Make sure you are sedating a calm horse, if the adrenaline is pumping first it won't work. Once you've jabbed the horse get your gear out the car, ask for a bucket of water and then 5-10 minutes will have gone by and the horse will be sedated.

A bit of mild ataxia isn't really an issue, usually they stand like a trestle table, just don't let them get their back legs too close together. If you have a real panic you can always reverse it with atipamezole (I give 1ml/horse IV).

Re: Sedation Techniques for Rasping

Hannah Wynne Richards — Thu, 29 Sep 2011 09:40:02 GMT

Agree with Mark,and give it plenty of time to work

Wynne

Re: Sedation Techniques for Rasping

Mark Rowland — Thu, 29 Sep 2011 08:50:00 GMT

Are you sure it went IV, Ive seen intra arterial alpha2 cause profound sedation and then rapid recovery in horses.

I would use alpha 2 again plus torb if it were me, Try Domoseden/torb

Goodluck