Quick sedation gains ground as a clinical tool in dogs and cats

CURRENT FULL VERSION: A new How Do You Treat That? discussion from Dr. Andy Roark’s Cone of Shame podcast highlights a daily reality in small animal practice: sometimes the fastest route to good medicine is sedation. In this episode, Roark frames “brief sedation” as something he is reaching for more often because of time and financial constraints, asking how to get patients sedated, complete needed care in a fear-free, low-pain or no-pain way, and then recover them efficiently. Guest Tasha McNerney, CVT, VTS (Anesthesia), joins him to talk through brief sedation in healthy dogs and cats, including low-pain and no-pain visits as well as more involved cases where actual surgical work may still need to be done under sedation rather than full anesthesia. That framing aligns with a wider shift in companion animal medicine toward earlier, more intentional use of sedation for fearful, painful, or hard-to-handle dogs and cats. Current AAHA guidance treats anxiolysis, sedation, and premedication as part of a continuum, with drug selection tied to patient health, handling needs, and desired depth of effect. (aaha.org)

That shift didn’t happen in a vacuum. Over the past several years, fear-free handling, feline-friendly care, and staff safety concerns have pushed clinics to rethink the old threshold for “needing sedation.” Educational materials for fractious patients now routinely discuss pre-visit pharmaceuticals the day before and day of the appointment, especially gabapentin and trazodone, as a way to reduce fear, anxiety, and stress before the patient even enters the building. In parallel, specialists continue to stress that chemical restraint is often safer than escalating physical restraint, particularly when pain, aggression, or repeated handling are part of the case. Roark’s setup for the episode also reflects another real-world pressure point: brief sedation is sometimes part of a practical middle ground when clients cannot pursue a full anesthetic workup or procedure but the patient still needs care now. (vetmed.auburn.edu)

The drug toolbox is familiar, but the nuance matters. AAHA’s 2020 anesthesia and monitoring guidance lists gabapentin at 50 to 150 mg per cat or 20 to 40 mg/kg in dogs given two to three hours before the visit, trazodone at 3 to 7.5 mg/kg orally in dogs, and dexmedetomidine among options for deeper sedation, alongside opioids, benzodiazepines, and acepromazine depending on the patient and goal. For cats, published and educational sources continue to note that gabapentin is a mainstay for pre-visit calming, while trazodone is used in some protocols, often at fixed per-cat dosing rather than mg/kg. In the podcast, McNerney’s focus is specifically on otherwise healthy patients without comorbidities, which is an important boundary around any “quick sedation” conversation: these are not one-size-fits-all shortcuts for medically fragile animals. (aaha.org)

There’s also emerging evidence behind combination approaches. A 2024 feline study indexed in PubMed evaluated oral trazodone, gabapentin, and their combination in healthy cats, while a related report found the trazodone-gabapentin combination increased sedation scores compared with gabapentin alone, with mild hemodynamic and echocardiographic effects in healthy cats. That doesn’t make combination therapy a universal answer, but it does support what many clinicians have observed in practice: for some feline patients, gabapentin alone may not be enough when the goal is a smoother exam, transport, or minor procedure. (pubmed.ncbi.nlm.nih.gov)

On the canine side, dexmedetomidine remains an important part of the conversation, but it’s worth separating labeled use from broader clinical practice. FDA-approved Sileo is indicated for treatment of noise aversion in dogs and is delivered as an oromucosal gel, not as a general-purpose in-clinic sedation product. Its labeling also carries notable precautions, including avoidance in dogs with severe cardiovascular, respiratory, liver, or kidney disease, shock, severe debilitation, or extreme stress states. That matters because “quick sedation” conversations can blur the line between situational anxiolysis at home and medically supervised sedation in the hospital. (animaldrugsatfda.fda.gov)

Expert education in anesthesia and handling continues to reinforce a broader point: speed should not come at the expense of planning. Specialist teaching materials emphasize matching protocol to temperament, pain status, comorbidities, and the reversibility of drugs used. They also note that some patients are better served by moving directly to a brief, controlled anesthetic event rather than trying to stack sedation in a way that still leaves the team struggling with restraint. Roark illustrates the practical edge of that decision-making with a dog-fight wound case in which the patient needed cleaning and suturing, but the owners did not have the resources for full anesthesia. In other words, “quick” works best when it’s protocolized, monitored, and realistic about the procedure being attempted. (vetanesthesiaspecialists.com)

The surrounding Cone of Shame conversation also points to why this topic resonates beyond pharmacology. In another episode, behavior specialist Tabitha Kucera discusses lunging dogs, high-FAS patients, and the common client push to “just get a muzzle on him and let’s get this done,” underscoring how often veterinary teams are asked to work through fear and escalation rather than prevent it. And in a separate ethics-focused discussion, emergency and critical care specialist Dr. Nathan Peterson explores technician moral distress when staff feel they are participating in care that prolongs suffering or leaves them without a meaningful veto. Together, those episodes reinforce that sedation decisions sit at the intersection of patient welfare, team safety, workflow, and the emotional burden placed on technicians and assistants.

Why it matters: For veterinary professionals, the practical value of fast sedation is bigger than convenience. It can improve staff safety, reduce patient distress, increase the odds of obtaining diagnostic-quality imaging or samples, and help preserve trust with the pet parent by avoiding visibly traumatic restraint. It can also create a workable option in selected healthy patients when time or finances rule out a more traditional anesthetic path but treatment still needs to happen. Just as importantly, better sedation planning may reduce the repeated high-stress handling that contributes to team frustration and moral strain. At the same time, clinics need clear guardrails: pre-visit sedation instructions, screening for cardiac or respiratory risk, informed consent, and monitoring standards that reflect the true depth of sedation being used. (aaha.org)

What to watch: The next phase will likely center on more species-specific evidence, especially around oral combination protocols in cats and workflow-friendly home-to-clinic sedation plans in dogs, as practices look for approaches that are both safer and more predictable without overextending the limits of outpatient handling. Expect that conversation to keep expanding beyond drug choice alone to include fear-free handling, technician wellbeing, and clearer decision points for when sedation is appropriate versus when a controlled anesthetic event is the better call. (pubmed.ncbi.nlm.nih.gov)