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Animal Health SmartBrief Special Report:
Pain management, sedation and anesthesia
in companion animals | | This Animal Health SmartBrief Special Report explores news and trends in clinical pain management, sedation and anesthesia in companion animals from the perspectives of researchers, veterinarians and pet owners. If you don't receive Animal Health SmartBrief daily and find our report on pain management, sedation and anesthesia in companion animals useful, sign up for this timely e-newsletter. Animal Health SmartBrief delivers the day's top animal health stories directly to your inbox – for FREE. |  | Sedative & Analgesic for Dogs & Cats
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| Sedatives, anesthetics and analgesics: Research in focus |  |  | | - Interleukin-10 tested for neuropathic pain in dogs
Veterinarian Robert Landry, a diplomate with the American Academy of Pain Management, is teaming up with University of Colorado professor Linda Watkins in a therapeutic trial involving interleukin-10 to treat animals with chronic, debilitating neuropathic pain. Two dogs treated so far have shown positive results, and the treatment may one day prove useful in treating pain in humans. Daily Camera (Boulder, Colo.) (12/14)      - Research explores anesthesia protocols in cats
Researchers comparing ketamine and propofol continuous infusion with ketamine, propofol and dexmedetomidine continuous infusion in cats undergoing ovariectomy found that the dexmedetomidine combination resulted in significantly deeper sedation. While both groups had smooth induction and good analgesia during the procedure, the group that also received dexmedetomidine experienced longer postoperative sedation. The authors speculate that the dexmedetomidine protocol may be an option for use in emergency situations and cases where postoperative pain is substantial. Journal of the American Veterinary Medical Association (subscription) (11/15/2012) - Study assesses utility of preanesthetic agent
In this clinical trial, investigators studying induction and anesthetic drug doses and pain control in 184 feline surgical patients found that dexmedetomidine used as a preanesthetic resulted in significant improvements over placebo for several parameters, including lower post-operative pain scores in the cats who received dexmedetomidine. The authors note that dexmedetomidine may enhance the action of other agents and concomitant use should be monitored and doses adjusted accordingly. Historically, veterinarians have been concerned about bradycardia in patients who receive dexmedetomidine, but the authors note that combining it with ketamine may ameliorate the issue. Journal of the American Veterinary Medical Association (subscription) (2/15/2012) | Clinical applications | | | | - Sedation, analgesia help cat recover from chemical burns
A cat that suffered severe, generalized burns over much of his body is on the mend, thanks to the efforts of veterinarians who treated him with analgesia, sedation, serial bandage changes and wound care to clean and dress the burns until they began to heal. When the cat, named Hades, returned home after being missing for two days, his owners noticed his fur was falling out in clumps and they rushed him to an animal hospital, where clinicians said the burns were likely caused by contact with a chemical. Hades' coat is beginning to grow back, but his owners are just happy to have their beloved cat home. The Independent (London)/The Press Association (U.K.) (1/4) - Managing neuropathic pain in pets
When a cat with a limb amputation suffers from repeated but intermittent bouts of acute pain, veterinarian Jeff Nichol recommends a course of pain medications aimed at alleviating the neuropathic pain that often accompanies limb amputations. Dr. Nichol emphasizes the importance of preventing pain before surgery commences and continually monitoring the patient after the procedure to minimize pain and maximize the pet's quality of life. Albuquerque Journal (N.M.) (subscription required) (1/7) | Pet owner's perspective | | | | - Pet dental cleaning should be under general anesthesia
While many procedures can be performed with the patient sedated, veterinary technician Christina Holland emphasizes the importance of general anesthesia for dental cleanings. Holland writes that animals under anesthesia are intubated and have a peripheral intravenous catheter, and these measures allow for a thorough, comfortable cleaning and exam while keeping the patient safe by allowing the veterinarian to respond quickly if an emergency arises. The Airdrie City View (Alberta) (12/21) - Explaining arrhythmia under anesthesia
When a pet owner asks about arrhythmia under general anesthesia, veterinarian Padma Yadlapalli explains that the issue can result from medications or underlying medical problems. Dr. Yadlapalli writes that in most cases, the arrhythmia can be corrected, but she recommends a frank conversation with a veterinarian to discuss the risks and benefits of anesthesia and the procedure for which it's needed. Dr. Yadlapalli emphasizes that dental cleanings under anesthesia are an important part of preventive care. The Baltimore Sun (1/11) | Expert's perspective | | | | - A conversation with veterinarian Christopher G. Byers
Animal Health SmartBrief spoke with Dr. Christopher G. Byers, a spokesman for the American College of Veterinary Internal Medicine and internal medicine and emergency/critical care specialist at MidWest Veterinary Specialty Hospital in Omaha, Neb., about clinical use of sedation and anesthetics.
For our lay readers, please explain the distinctions between sedation, preanesthesia and anesthesia.
Sedation for patients implies the administration of a drug to help a patient feel more relaxed and comfortable to facilitate a diagnostic or minimally invasive medical procedure. Preanesthetic agents are given with the objective of making anesthesia safer for a patient. Preanesthetic drugs provide sedation, work to ensure smooth and rapid induction of anesthesia, help counteract against some potential adverse effects of anesthesia and deliver pain relief. Nearly all patients benefit from administration of preanesthesia before surgery. Anesthesia is most commonly used to minimize pain for surgical patients. There are several types of anesthesia, including general, local and regional. Can you talk about some recent trends in pain management for clinical procedures, sedation and anesthesia? Today we as veterinarians readily recognize our patients experience pain, and as such, one of our top priorities as a profession is to help alleviate that pain. The basic principles of current pain management include pre-emptive analgesia, a multimodal approach and appropriate follow-up. Drugs are used in various combinations to inhibit the nociceptive process at more than one site. For this reason, combinations are more effective than single agents. For me, one of the most exciting approaches to pain management is the use of local and regional anesthetic agents. Applying analgesia directly to the affected nerve endings may provide excellent pre-emptive pain control while reducing the need for systemic drugs. The growing popularity of sports medicine and rehabilitation also offers some potentially useful adjunct modalities for both acute and chronic pain management. There are obvious major-surgery applications for anesthetics. Can you discuss some more minor clinical procedures where anesthetics are useful or essential? Some of the minor procedures for which sedation and/or anesthesia may be beneficial include orolaryngeal examinations, orthopedic examinations, restraint/manipulation for radiographs, skin laceration repair, placement of urinary catheters and placement of central venous catheters. Use of sedatives and anesthetics for these types of procedures allows the clinician to perform necessary diagnostic tests and/or treatments, all the while minimizing stress and discomfort to the patient. A lot of pet owners are concerned about the use of sedatives and anesthesia. What is the scientific basis for these concerns, and how should veterinarians address them? Use of sedatives and anesthetic agents is not a risk-free undertaking! Indeed, each medication has potential side effects. Therefore, there are some very important steps every clinician should take prior to administration of these drugs: - Obtain a complete patient history
- Perform a thorough physical examination
- Collect a minimum database of laboratory data (i.e.: complete blood count, serum biochemical profile, urinalysis)
Without question, obtaining a complete patient history and performing a thorough physical examination are the two most important initial diagnostic tests for any patient. An astute clinician should be able to identify increased risk factors for potential complications with sedation and/or anesthesia; one may detect abnormalities that may influence drug selection. Adverse reactions may be exacerbated by dysfunction of major organ systems, so proactive evaluation of non-invasive blood and urine tests is recommended to ensure appropriate hepatic and renal function, as well as to ensure red blood cell, white blood cell and platelet counts are adequate. My team and I are explicit about recommendations, both when verbally explaining issues and with written documentation. We take the approach that pre-anesthetic screening will be done. The estimate we give for surgery includes the recommended tests. A technique I have found helpful is to state the recommended tests are very similar to the tests our own anesthesiologist would recommend for us -- I find most parents understand this concept from personal experience; they understand it was important for them, and for similar reasons it is important for their pet. | | | 
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