SEDATION OF

DIFFICULT
DOGS
General Rules of Thumb
(How to Keep Your Thumbs)
 Ability to decline patients
 Muzzled before arrival if dangerous
 Set aside adequate time
 Charge for your time
Safety First!
 Health of pet vs. intact vet
 Liability (owner injury)
 Liability (patient injury)
 Adequate staff
 Adequate equipment
 Adequate drugs
Oral Sedation
 http://www.vasg.org/oral_sedation_for_diffic
ult_dogs.htm
 Usually inadequate (easily overridden)
 False sense of security
 Keep your health insurance up-to-date if
using this method routinely
Oral Sedation (continued)
 Acepromazine: 0.5-2.0 mg/kg
 Diazepam: 1.0-2.0 mg/kg (disinhibition)
 Alprazolam: 0.1-0.5 mg/kg (disinhibition)
 Combinations:
 Telazol 10-20 mg/kg w/ Acepromazine 2
mg/kg: given in a “meatball” at home;
profound sedation, long recovery
Oral Sedation (continued)
 Acepromazine 1-2 mg/kg w/ Diazepam 0.5-
1.0 mg/kg
 Phenobarbital 2.5 mg/kg w/ Diazepam 0.5-
1.0 mg/kg
Injectable Sedation
 Better when combinations of drugs are
used
 Opioids form the basis of most
combinations (neuroleptanalgesia)
 Unless anesthetized, any dog can bite
 Unless anesthetized, any dog can bite
Opioids– Which one and why?
 Nalbuphine: 0.4 mg/kg; very inexpensive,
not controlled, variable sedation
 Butorphanol: 0.2 mg/kg; moderately
expensive, C IV, mild to moderate sedation
 Buprenorphine: 0.010-0.020 mg/kg;
expensive, C III, usually not recommended
due to minimal sedative qualities
Opioids (continued)
 Mu agonists– very inexpensive, C II, more
side effects (bradycardia, vomiting, etc.)
 Morphine: 0.5-1.0 mg/kg IM (if used IV, give
very slowly to minimize histamine release)
 Hydromorphone: 0.1-0.2 mg/kg IM, IV
 Fentanyl: 0.005-0.010 mg/kg IM, IV
Medetomidine/Opioid (Domitor)
 Profound sedation, good analgesia
 Rare catecholamine override
 Moderately expensive
 Side effects include bradycardia, initial
hypertension
 Avoid if cardiac disease, organ failure
 Add anticholinergic if brachycephalic or
vagal stimulation anticipated
Medetomidine/Opioid (cont.)
 Medetomidine dose: 0.005-0.040 mg/kg IM
or IV (low end if IV)
 Increasing dose increases duration and
degree of sedation
 Can add induction agent (watch doses!) if
sedation insufficient
 Reversible with atipamezole (Antisedan)
Acepromazine/Opioid
 Variable sedation (usually good)
 Side effects include hypotension,
hypothermia, rare collapse (Boxers)
 Very inexpensive
 Reasonably safe with cardiac disease
(caution with forward failure)
 Acepromazine dose: 0.01-0.1 mg/kg IM, IV
 Long duration, irreversible
Benzodiazepine/Opioid
 Midazolam preferred for IM use
 Variable sedation (better in geriatric or
compromised patients)
 Fewest CV effects
 Variable expense (midazolam>diazepam)
 Benzo dose: 0.1-0.4 mg/kg IM, IV
 Short duration; reversible with flumazenil
Telazol (tiletamine/zolazepam)
 Dissociative/benzodiazepine (anesthetic)
 Can be used alone (better with opioid)
 Expensive; minimal analgesia alone
 Short duration anesthesia, long, rough
recovery (tiletamine>zolazepam duration)
 Caution with CV, organ disease
 5-10 mg/kg IM; 2-5 mg/kg IV
 SUMMARY

•Better living through

chemistry
•Domitor is your
friend
•Safety, safety,
safety