Feline procedural sedation and analgesia: When, why and how

Abstract

Practical relevance: Procedural sedation and analgesia (PSA) describes the process of depressing a patient’s conscious state to perform unpleasant, minimally invasive procedures, and is part of the daily routine in feline medicine. Maintaining cardiopulmonary stability is critical while peforming PSA. Clinical challenges: Decision-making with respect to drug choice and dosage regimen, taking into consideration the cat’s health status, behavior, any concomitant diseases and the need for analgesia, represents an everyday challenge in feline practice. While PSA is commonly perceived to be an uneventful procedure, complications may arise, especially when cats that were meant to be sedated are actually anesthetized. Aims: This clinical article reviews key aspects of PSA in cats while exploring the literature and discussing complications and risk factors. Recommendations are given for patient assessment and preparation, clinical monitoring and fasting protocols, and there is discussion of how PSA protocols may change blood results and diagnostic tests. An overview of, and rationale for, building a PSA protocol, and the advantages and disadvantages of different classes of sedatives and anesthetics, is presented in a clinical context. Finally, injectable drug protocols are reported, supported by an evidence-based approach and clinical experience.

Clinical pharmacology of tramadol and tapentadol, and their therapeutic efficacy in different models of acute and chronic pain in dogs and cats

“…In cats, opioids are not always considered first-choice drugs owing to the reduced glucuronidation activity that can increase the risk of toxicity when doses and intervals are not administered appropriately [ 80 ]. The main side effects following high doses of tramadol are sympathetic responses such as mydriasis, hypertension, tachycardia, and an increase in adrenal hormone concentration (e.g., NE, epinephrine, dopamine, met-enkephalin).…”

“…Experimentally, tramadol (1 mg/kg) and acepromazine (0.1 mg/kg), both SC, were evaluated on pressure and thermal thresholds. Tramadol monotherapy offered limited effects on nociceptive thermal and pressure stimuli, but improvements were observed when administered with acepromazine [ 80 ]. In many cases, the neuroleptoanalgesia afforded by acepromazine increases the weak analgesic effect of the opioid.…”

Echocardiographic assessment of felines sedated with dexmedetomidine or xylazine associated with butorphanol

“…Surgical and/or diagnostic procedures in cats may require intense sedation or even general anesthesia. Depending on the anesthetic protocol used, it is possible to observe prolonged recovery time of the patient, a fact that requires greater monitoring and involves a higher incidence of side effects (Papastefanou et al, 2015;Simon & Steagall, 2020). The benefits of using sedative protocols in cats aim to reduce excitability, fear and stress derived from the manipulation process (Simon & Steagall, 2020).…”

“…Depending on the anesthetic protocol used, it is possible to observe prolonged recovery time of the patient, a fact that requires greater monitoring and involves a higher incidence of side effects (Papastefanou et al, 2015;Simon & Steagall, 2020). The benefits of using sedative protocols in cats aim to reduce excitability, fear and stress derived from the manipulation process (Simon & Steagall, 2020). Dexmedetomidine is a α2-adrenergic receptor agonists drug such as xylazine, detomidine, medetomidine, clonidine and romifidine (Papastefanou et al, 2015;Murdock et al, 2020).…”

“…One advantage of using α2-adrenergic agonists is the possibility to reverse their effects with selective antagonists such as atipamezole (Robertson et al, 2018;Simon and Steagall, 2020). When combined with opioids (Simon & Steagall, 2020), α2-adrenoceptor agonists have shown to exert additive and/or synergistic effects on analgesic and sedative effects (Ahsan et al, 2020). Butorphanol is a kappa opioid agonist and μ-antagonist (Murdock et al, 2020).…”