Sedation before Euthanasia?

Re: Sedation before Euthanasia?

Louise Buckley — Sat, 20 Mar 2010 23:54:33 GMT

[quote user="Malcolm Ness"]

Not convinced about pre-euthanasia sedation. If you are going to have the delay then why not just give an intraperitoneal injection of petobarb?? Abdomens are generally easier to hit than veins.

[/quote]

Interesting! I have always wondered why i/p isn't more favoured. I presumed that it was because pentoject might cause abdominal pain when injected i/p. When euthanasing rodents/birds/rabbits in this way it is my experience that many vets (and nurses under direction) will anaesthetise the patient first which I sometimes question (in my head) as they seem to find this aversive.

In the research environment, I exclusively use the i/p method in preference to i/v access as I find it tolerated particularly well and rarely associated with any kind of behavioural stress response. In fact, it seems pretty rare for them to realise they have been injected. My observations though suggested that the recommended amount for i/p injection was far too small to ensure a reliable reasonably rapid response. I would use 1 - 2ml/kg and occasionally found an i/v top up was necessary once unconscious. I never observed any transitional excitatory behaviour with this so it might be a useful method for owners who want their animal to die (or at least fall asleep) in their arms rather than being restrained for i/v access. I work with birds (<4.5kg) though so whether my experiences are necessarily translatable to companion animals is another matter. I cannot see any practical reason why not in smaller animals (I am thinking circa cat size here) but would welcome comment.

Re: Sedation before Euthanasia?

ms1083 — Tue, 23 Feb 2010 21:22:01 GMT

I second the ketamine midazolam comination for cats, its brilliant, no vomiting very quick & smooth. I use about 0.2ml ketamine combined with about 0.3ml midazolam (0.25mg/kg) given IM in lumbar muscles. Despite ketamine stinging I have rarely found this to occur. After about 2 mins the cat is totally out of it and I either give pentobarb IV or intra-kidney. I rarely give pentobarb straight IV from conscious if the owner is present nowdays as they seem to appreciate not having to call in a nurse to restrain the cat and it is able to go sleepy with them stroking/hugging it.

Ketamine is very cheap, midazolam is relatively cheap but to save wastage I have decanted a vile into a plain cow blood sample tube (red top) so it can be drawn up when needed. Also, I charge the owner for the drugs ontop of the PTS fee.

Re: Sedation before Euthanasia?

Jacquin Mitchell — Tue, 23 Feb 2010 20:19:03 GMT

That is incredibly helpful. Thank you so much for that protocol.

Jacq

Re: Sedation before Euthanasia?

Karen Eggleton — Tue, 23 Feb 2010 19:02:16 GMT

[quote user="Michael Woodhouse"]how long does it take (all in, from arriving to leaving) and how much do you have to charge to make it profitable?[/quote]

It takes no more than 5 minutes for the cats to be nicely asleep. A bit more variable for dogs, usually 10 mins, worst case 20.

I probably charge double what you may pay in a traditional clinic but I allow for time and I don't have a visit charge so i guess I am actually better priced than a routine home visit for euthanasia.

It is an important part of my practice so it is important it goes as smoothly as things will allow

Re: Sedation before Euthanasia?

Vikki Halliday LLB — Tue, 23 Feb 2010 11:27:23 GMT

[quote user="Malcolm Ness"]If you are going to have the delay then why not just give an intraperitoneal injection of petobarb?? Abdomens are generally easier to hit than veins.[/quote]

I agree. Have started doing IP injections where time is not an issue and where veins are hard to hit, and the owners were very appreciative that they were holding their animal whilst it slipped away, not being restrained by a nurse and having a painful IV injection. It can however take up to 40 mins but generally 15-20 mins to take effect.

Re: Sedation before Euthanasia?

Michael Woodhouse — Mon, 22 Feb 2010 23:28:19 GMT

If you don't mind me asking, how long does it take (all in, from arriving to leaving) and how much do you have to charge to make it profitable?

Re: Sedation before Euthanasia?

Karen Eggleton — Mon, 22 Feb 2010 23:20:08 GMT

Dogs I use Big MAK: Midazolam( the stronger concentration hypnovel) , ACP, ketamine 1ml/1ml/1ml per kg.

Sorry-that should be 1ml/1ml/1ml per 10kg.

Loving wing set catheters also for dogs so I can be a little distant when injecting.

I have only had one client not like the idea of pre euthanasia sedation and I will do it in all cases now excepting very good dogs that I know will allow catheter placement without batting an eyelid. Euthanasia should be a 'good death' as the term implies and I don't see much good in using excessive restraint which can be the case sometimes. I think clients appreciate the time involved, it appears to not be a negative thing.

I will also no longer touch Dom with a bargepole for pre-euthanasia.Unpredicatable, lowers blood pressure horribly, and makes barbiturate effect hit & miss . Had my worst ever euthanasias with this. Ditto ketamine on its own

Re: Sedation before Euthanasia?

Karen Eggleton — Mon, 22 Feb 2010 23:03:53 GMT

I work housecall and do all PTS solo so after 20 months of trial & error, Iam now happy with my protocol.I use midazolam & ketamine in cats 0.1/0.1ml per kg, slow IM or occassionally subcut then, once reflexes gone, use a lovely cheap JAK tourniquet & IV. Dogs I use Big MAK: Midazolam( the stronger concentration hypnovel) , ACP, ketamine 1ml/1ml/1ml per kg.Slow IM. Gives beautiful sedation, great veins, no gasp, no rigidity & no vomiting (will probably have a euthanasia tomorrow that does all of the above...)Americans use Telazol but extortionate to import and this seems to do the equivalent very nicely.

Re: Sedation before Euthanasia?

Vikki Moran — Wed, 17 Feb 2010 23:22:39 GMT

I tend to use intrarenal if i've struggled to get a vein (either not clipped or used our silent cat clippers, moser ones, which are brilliant!). Or in very fractious cats.

I find it's not the reaction of the cat that's the issue to intrarenal, it's the owners. they don't like the idea of their cat being injected into the kidney. they seem to think it must be "cruel", so I think it's not really me first line approach.

I've also done a few intracardiac in cats that have had an i/v or i/r or even intra cat in some cases, and have slipped out of consciousness, and just used 0.5 ml to end the job. again, not something i would do in front of a client, but sometimes it's the quickest thing you can do. Of course i would not ever do that in any animal that was in any way conscious.

Re: Sedation before Euthanasia?

Michael Woodhouse — Tue, 16 Feb 2010 22:27:08 GMT

[quote user="Gillian Mostyn"]

[quote user="Michael Woodhouse"]We have no proper nurses. Just lay staff to help if required.[/quote]

In a practice where you do anaesthesia and surgery??

But I guess that's a whole different thread......

[/quote]

I know a number of lay people with no qualifications who are just as useful as a 'qualified' VN.

A totally different debate, that if you start a thread I will be more than happy to contribute too!

(we don't do enough small animal work to justify a nurse, some weeks we may do no operations, mostly large animal practice)

Re: Sedation before Euthanasia?

Gillian Mostyn — Tue, 16 Feb 2010 22:15:47 GMT

[quote user="Michael Woodhouse"]We have no proper nurses. Just lay staff to help if required.[/quote]

In a practice where you do anaesthesia and surgery??

But I guess that's a whole different thread......

Re: Sedation before Euthanasia?

Michael Woodhouse — Tue, 16 Feb 2010 21:49:32 GMT

[quote user="Jacquin Mitchell"]

[quote user="stuart mcmorrow"]Suppose depends on how good the nurses are - mine are excellent.[/quote]

If you read my OP you'll see I don't have a nurse - thats why I'm asking the question in the first place!

jacq

[/quote]

We have no proper nurses. Just lay staff to help if required.

Re: Sedation before Euthanasia?

Jacquin Mitchell — Tue, 16 Feb 2010 21:42:55 GMT

[quote user="stuart mcmorrow"]Suppose depends on how good the nurses are - mine are excellent.[/quote]

If you read my OP you'll see I don't have a nurse - thats why I'm asking the question in the first place!

jacq

Re: Sedation before Euthanasia?

stuart mcmorrow — Tue, 16 Feb 2010 20:38:33 GMT

Intra-renal is brilliant. I use it all the time. I check the cat is likely to be OK with it first by having a feel of the abdomen and then get on with it. The owners can usually cuddle the cat up to the last without the need for restraint.

I never have had the need to sedate dogs or cats before PTS unless they are very aggressive. Suppose depends on how good the nurses are - mine are excellent.

Re: Sedation before Euthanasia?

Gillian Mostyn — Tue, 16 Feb 2010 15:05:32 GMT

I do use intra-renal but only as a fall-back option when iv has failed/no vein.... Perhaps I'm being too anthropomorphic as I agree - they rarely react - but I still think I wouldn't like it doing to me. But then I don't like ivs either.....

Re: Sedation before Euthanasia?

Malcolm Ness — Tue, 16 Feb 2010 08:51:18 GMT

Why is everybody so keen to clip up the leg? A generous slosh of surgical spirit followed by a smoothing down with cotton wool and the course of the vein is obvious in pretty much every cat. IV using a 25 g needle.

Not convinced about pre-euthanasia sedation. If you are going to have the delay then why not just give an intraperitoneal injection of petobarb?? Abdomens are generally easier to hit than veins.

Re: Sedation before Euthanasia?

Richard Carter — Mon, 15 Feb 2010 15:57:18 GMT

[quote user="Mike Martin"]

[quote user="Michael Woodhouse"]Prepares to be shot down in flames, but are people really going IV to euthanase cats? What's wrong with intra-kidney? They don't react, it's easy on your own and as quick as IV. No need to scare it with clippers, no need for any help.[/quote]

I agree. Intra-kidney is painless, quick and effective (in cats). But I don't know if they teach that route in Uni? I learnt from senior colleagues in practice. Initially shocked at the thought, but amazed at how effective it is.

[/quote]

Support the above -and I do give it in front of clients. And if you miss, you have a sedated cat very quickly where you can then clip up legs etc without pinning to the table

Re: Sedation before Euthanasia?

Mike Martin — Mon, 15 Feb 2010 09:00:27 GMT

Re: Sedation before Euthanasia?

Michael Woodhouse — Sun, 14 Feb 2010 22:47:01 GMT

[quote user="salome2001"]

Versus EMLA cream and clipping hair with scissors rather than clippers?

[/quote]

Please don't think of me as rude, but when I was @ college they were doing a trial on the effectiveness of EMLA cream and it had to be left in situ for 20-30 minutes to take effect.

Usually I want a PTS over with as quickly as possible as however we try to put them before of after surgery there is always something else waiting requiring my attention.

People often comment how quick and painless things were. Not sure they'd like the charade of clip with scissors, apply cream and occlusive dressing. Occupy self for half an hour with death sentence cat, then place catheter etc etc.

I try to get euthanasia over with as quickly and calmly as possible with little fuss. I think our clients appreciate that.

Re: Sedation before Euthanasia?

Evelyn Barbour-Hill — Sun, 14 Feb 2010 17:41:07 GMT

[quote user="salome2001"]

[quote user="Michael Woodhouse"]

[Versus been restrained having hair clipped (cats hate that in my experience) and fiddling with an IV catheter. Then further restraint to inject into the catheter. .

[/quote]

Versus EMLA cream and clipping hair with scissors rather than clippers?

[/quote]

Yes.

Re: Sedation before Euthanasia?

salome2001 — Sun, 14 Feb 2010 15:28:49 GMT

[quote user="Michael Woodhouse"]

[Versus been restrained having hair clipped (cats hate that in my experience) and fiddling with an IV catheter. Then further restraint to inject into the catheter. .

[/quote]

Versus EMLA cream and clipping hair with scissors rather than clippers?

Re: Sedation before Euthanasia?

Michael Woodhouse — Sun, 14 Feb 2010 12:15:41 GMT

[quote user="Gillian Mostyn"]

If you had to receive a lethal injection, what method would you request???

[/quote]

The quickest most painless that was available to me.

If I was a cat I'm rather my owner was talking to me, cuddling my front end and stroking my head as the same 21G 5/8" needle slipped, unnoticed into my kidney and I went to sleep. Versus been restrained having hair clipped (cats hate that in my experience) and fiddling with an IV catheter. Then further restraint to inject into the catheter.

I have never had a pain reaction to intra-kidney injection, I've had many cats struggle for clipping and IV venopuncture.

Re: Sedation before Euthanasia?

Gillian Mostyn — Sun, 14 Feb 2010 11:39:36 GMT

If you had to receive a lethal injection, what method would you request???

Re: Sedation before Euthanasia?

Michael Woodhouse — Sun, 14 Feb 2010 00:30:49 GMT

Prepares to be shot down in flames, but are people really going IV to euthanase cats? What's wrong with intra-kidney? They don't react, it's easy on your own and as quick as IV. No need to scare it with clippers, no need for any help.

Also if a dog so agressive that it needs sedating I have always given lots of dom/torb (xylazine if home PTS as don't carry small animal sedatives in the car) and when sedated intra cardiac. Would only do that if sedated or comatose.

Re: Sedation before Euthanasia?

Vikki Halliday LLB — Tue, 02 Feb 2010 21:56:12 GMT

[quote user="Vikki Halliday"]

Good tip about holding the leg off the table though! Haven't tried that so will bear it in mind.

[/quote]

Had to try this yesterday and it works! Thanks although I feel like an eejit for not thinking of it earlier.............