Our members webinar on the 10th of September was on the topic of ‘Safe Sedation in Practice’. Almost every day, you’ll be sedating animals and it’s not quite as simple as putting them in a deep twilight sleep and waking them up when it’s time to go home. Carl Bradbook, a specialist in veterinary anaesthesia and analgesia, covers doses, medications and strategies to ensure safe sedation for your patients.
Do I sedate or anaesthetise?
Some clinics choose to anaesthetise animals fully when they go into diagnostic imaging, whereas others sedate lightly and reduce stimulus. The choice between the two can be quite an important one. Brachycephalics are more likely to do poorly under sedation because of their compromised airways, and procedures with lots of stimulus (joint taps) are more likely to rouse the patient out of their sedation. You don’t exactly want a dog leaping up off the table mid-CSF collection.
If you have experience with a procedure and you’re pretty confident you can get your U/S scan done in a reasonable time, then you might be able to get away with a sedated animal. If you’re a new graduate or the patient is going into surgery after, perhaps anaesthesia might be a better choice.
How do I sedate safely?
There are 5 key points for safe sedation. These are:
- Ensure good patient monitoring
- Consider appropriate drugs
- Consider Route of admin
- Calculating, drawing up, and administering drugs.
- Giving as much sedation as appropriate for the patient and circumstances.
The principles that you should keep in mind are patient safety, appropriate drugs, routes of administration, gain IV access ASAP, ensure adequate time for the drug to take effect, and supplement oxygen as required.
Monitoring is equally important. As a legal requirement but also as a reference point. If you see that the anaesthetic is particularly poor one day, you’re able to check back on why that might be. Remember to monitor the patient into the recovery period as well! The anaesthetic doesn’t stop when the dog is off the table. I have seen dogs regurgitate in the kennel when someones back is turned, or dogs leap up off the table once they’ve been extubated. Always keep an eye on your patient until they’re up and about.
My sedation isn’t working!
When your sedation protocol isn’t working, it can be stressful. You want to minimise stress to your patient (and to your team!) and having an aggressive or nervous dog running about the room isn’t exactly calming. If you can get a hand on the patient, ensure that the IV is patent. You should also check the time since drug administration and the previous doses.
In the case that you’ve got a patient undergoing a procedure that starts to wake, double check your positioning. An old arthritic dog is going to be getting stimulus if it’s laying on its bad hip. For long procedures like full abdominal ultrasounds, a dog with a bad back will be in pain from dorsal recumbency. Consider analgesic in these cases, on top of butorphanol as a premed have you considered adding a mu agonist?
When sedation becomes refractory – that is, you start prodding and the dog opens its eyes or shifts – have a look to see how long it’s been since your last injection. Was it IM or IV? You can administer further sedation if you believe it appropriate, but also be aware that there will be effects on the recovery as well.
Putting it into Practice
The rest of the webinar is full of some great case studies that are worked through bit by bit. We have two patients who have ***CARE*** attached to their notes (don’t you love them). On the roster we also have patients with concurrent diseases like hepatic failure, hyperthyroid, and portosystemic shunts. There are all sorts of elements to be aware of – from hepatic disease affecting albumin production and thus intravascular volume, to puppies being more at risk to hypoglycaemia and hypothermia. For detailed protocols, I’d definitely have a look at the webinar – the case studies start about halfway through. You can find the webinar HERE.
If you’ve had an epiphany or just want to chat with some vets, have a look at our facebook page. We post summarised webinars, links to resources, and share interesting cases throughout the week.