The Sweet Seduction of Sedation

The drugs have been given, and the animal is in a deep slumber. Head down, body fully relaxed as they sleep. They suddenly flip their heads up and respond as you touch their body. Surprise! You have been seduced into thinking that sweet slumber was deep enough to prevent a reaction if you touch their body in any way.

I recently returned from the Illinois State Vet Med Association Conference, where there were lectures on anesthesia, procedure sedation, and, pre-euthanasia sedation. I am noticing more webinars and articles providing protocols about sedation cocktails for care. The expansion of injectable and Oral Transmucosal Routes of sedation medications provides more options for less stressful care. More pets than in years past can be medicated and yield to the sweet slumber through sedation. Yet, we need to remind ourselves of the limits of sedation in response to stimuli. In other words, sedation is not full chemical restraint. There is a continued effect of the brain-body response to stimuli.

Sedation is sweet at times

Sedation may be a safer alternative to anesthesia for some procedures. With good pain management and local anesthesia, many procedures are able to be achieved with sedation rather than anesthesia. At home, or at a grooming facility, sedation may be needed for less aggression for ear care, brushing, or wound care.   Deep sedation is often limited to a veterinary clinic, with mild sedation plans used at home or other facilities for less stressful care.  In both situations, I have witnessed people lulled into a sense of security that the animal was too sleepy to respond to the stimulus. Sedation is not a complete loss of consciousness or response to stimuli. They look pretty darn close, yet touch – noise- and light stimuli can rouse many a sedated patient. This “seduction” is where bites can occur. This rousability can be a form of dysphoria – an altered state of consciousness, often with increased agitation to stimuli.  

Adrenaline and norepinephrine are the primary brain and body chemicals that rise with stimuli to the senses – noise, touch, and movement.  If an animal is already stressed, struggling or acting aggressively when sedation medications are given, the effects are far less due to the negating effects of these important neurotransmitters.   This is why medicating when the patient is calm, at high doses is essential for the best effect in patients with a history of anxiety or aggression. If you need to sedate due to behavior, it is more likely that dysphoria will occur. Adrenaline runs naturally higher in these animals. The greater the combination of drugs used to create the cocktail, the more control one often has over the dysphoria and adrenaline effect.  In short, if you pet has been given a combination of three drugs for a sedation cocktail, this is best.  The overall dosages of each drug are lower than if one was used alone, and the combined effect helps lower the incidence of dysphoria.

I often called the dysphoric state the “mean drunk” to help clients understand why their pet may act off when sedated.  This effect cannot be predicted, just like a person who when inebriated may act out of line when you would not expect that.  Sedation is needed at times, so preparation as prevention for mishaps is best for you and your pet.  When you have a sedated patient, be sure to maintain some level of restraint. Use a basket muzzle, cover with a towel or blanket,  or apply an  Elizabethan collar  ( aka the cone of shame) to be prepared for any sudden response to touch, noise, or movement.   Keep the area where you are working quiet – no loud noises, people yelling or running around, or high-pitched equipment.  covering the eyes or face not only protects but also prevents the bright lights from triggering stimulation.    Do not hug, or lay close holding a sedated animal!  I see some social media posts of people hugging, holding their faces up to a post-operative patient.  Don’t do this!  In my  Bite Nr Bite Job Stress Survey  14% of respondents were bitten or near bitten when moving and settling a post-op patient into a recovery area.  Keep your face away, and use tools to comfortably maneuver the animal.

Quiet sedation, quiet recovery

Full recovery from sedation can take hours after they look awake.   Perception may be off, and the altered sensory input and stimuli can still trigger anxious or aggressive behavior.  I call this the “hung-over effect”.  The body and brain have to process and eliminate all the sedation medication and metabolites to get back to baseline.   If your pet has had sedation, leave them in a quiet room, alone for 8-12 hours to fully wake up.  Also, be sure pain relief medications are already in use.  Often the increased recovery dysphoria is aggravated by the discomfort from x-ray positioning,  surgical incision sensitivity, or even tender skin from grooming a heavily matted dog.  Pain relief may be given as part of the sedation medication, but be sure to ask if that is in use at the time of recovery.

For pet owners, ask all the effects typically seen with sedation, and how to minimize any problems from dysphoria.  Be sure to follow the advice of time to release your pet after sedation.  Some pets are exposed to too many stimuli at a clinic or groomers and need to be released early to minimize dysphoria.  So you may be taking home a very drunk pet, but that will help them recover better.  Be sure you are told what to expect, where to set your pet up to recover at home, and how to prevent overstimulation.   I have often advised my clients to put a “KEEP OUT!” sign on a bedroom door where the animal is recovering quietly.  This will prevent family members from wanting to check or love on a pet who is not ready for this yet.

Veterinary staff, use your Low-Stress Veterinary Care skills when handling sedated animals. Pheromone sprays such as Feliway and Adaptil/ Thunderease can decrease agitation when misted in a cage, on the bedding, and in the room for recovery.  Towels to cover the head and minimize light and sound stimulation can also be protective if the animal reacts. When you use these safety tools and products keep a watch on the animal for any response when you need to handle and stay safe!

I have a number of courses for veterinary staff to learn less stressful handling techniques.  These are available at my shop.  I also offer staff training in person or remotely.

Download the Staff training options and rate sheet here

For pet parents, I have multiple videos on my Youtube Channel DrSallyJFoote  demonstrating Low-Stress Care techniques you can use at home.   Courses for pet parents include

“Spicy Cat Home Care ” workshop  and more.

Thanks for your support, keep care Low-Stress and remember the Last Memory is the Lasting Memory.

Sally J Foote DVM, CABC-IAABC, LSHC-S, FFE

References :

Gatson, B. Handling “Ruff” Recoveries

https://www.mynavas.org/post/handling-ruff-recoveries

Efficacy of dog-appeasing pheromone for ameliorating Separation Anxiety signs in hospitalized dogs

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839826/