Pharmacologic Methods: An Update on Optimal Presedation and Euthanasia Solution Administration

Defining a "Good Death": Exploring Veterinarians' Perceptions of Companion Animal Euthanasia

This study was designed to determine how veterinarians define a good euthanasia experience. This information is used to generate a working definition of companion animal euthanasia that aligns with animal welfare standards and pet owners' expectations. An electronic survey distributed via veterinary-related social media (Facebook, Instagram) and listservs were completed by 249 veterinarians who perform feline and/or canine euthanasia. Our results suggest that very few veterinarians feel their veterinary school training adequately prepared them for euthanasia. When veterinarians were asked to rank a list of physiologic conditions and anatomical traits in order of euthanasia-related concerns, respiratory distress was ranked the highest, while the most concerning physical changes were reported to be indications or impressions of seizures or pain. The most commonly reported euthanasia injection technique performed by participants was intravenous administration of pentobarbital sodium (97%), and most veterinarians preferred having owners present (57%) or having no preference (38%) during euthanasia. Results suggest that veterinarians want a pain-free, anxiety-free experience for the patient, appreciate the use of sedatives before euthanasia, and feel that when available and appropriate, home euthanasia offers several benefits. This understanding of the numerous aspects involved in a good euthanasia experience can help inform the creation of an updated definition of companion animal euthanasia that strives to prioritize the welfare of the patient as well as the needs and expectations of the pet owner.

Euthanasia of Dogs by Australian Veterinarians: A Survey of Current Practices

Euthanasia techniques utilised by veterinarians impact the welfare of many dogs in their final moments. Despite euthanasia guidelines, little is known about euthanasia techniques used in practice. We administered an online survey of Australian veterinarians who had euthanised at least one dog in the previous 12 months. We found that 668 (96.8%) had euthanised a dog in the previous 12 months, almost all using intravenous pentobarbitone sodium (n = 651, 99.7%). For non-emergency euthanasia (n = 653), the majority (n = 442, 67.7%) administered a premedication or sedation prior to euthanasia versus less than half for emergency euthanasia (n = 286, 46.4%). Practices and views about euthanasia varied. Female veterinarians and veterinarians located in metropolitan regions were more likely to administer a premedication or sedation prior to non-emergency euthanasia (p < 0.05). Veterinarians in private mixed animal practices were less likely to administer a premedication or sedation prior to a non-emergency euthanasia (p < 0.05). For non-emergency and emergency euthanasia, veterinarians who worked in "other" practice types were more likely to administer a premedication or sedation than private companion animal practices (p < 0.05). The possible reasons for differences in euthanasia practices are explored, and scope for refinement is identified.

Euthanasia of dogs and cats by veterinarians in New Zealand: protocols, procedures and experiences

AIMS

To collect data on protocols used by New Zealand veterinarians to perform euthanasia of dogs and cats, and to explore opinions towards the training they received in euthanasia during veterinary school.

METHODS

A cross-sectional survey was administered to all veterinarians registered with the Veterinary Council of New Zealand. The survey asked respondents about their practices' policies for euthanasia; protocols for performing euthanasia of dogs and cats; opinions towards euthanasia training received in veterinary school; and subsequent experiences with euthanasia in practice. Descriptive statistics were provided for all quantitative study variables and thematic analysis was performed on the free-text comments.

RESULTS

The survey was completed by 361/1,448 (24.9%) veterinarians in companion or mixed animal practice. The mean number of dogs and cats euthanised each month were 7.2 (median 5; min 0; max 60) and 7.9 (median 5; min 0; max 60), respectively. Fewer than half of respondents reported that their clinic had a standard protocol for euthanising dogs (147/361; 40.7%) and cats (157/361; 43.5%). For euthanasia of dogs, 119/361 (32.9%) always used sedation while 71/361 (19.7%) indicated that they would not use sedation. For euthanasia of cats, 170/361 (47.1%) always used sedation while 53/361 (14.7%) indicated that they would not use sedation. Placement of IV catheters, methods for patient restraint, preferences towards the presence of owners during euthanasia, services provided with euthanasia, and discussions with owners were also highly variable and handled case-by-case depending on the client, patient, and clinical scenario. When asked about the euthanasia training received at veterinary school, it was generally ranked as below satisfactory, with approximately one third of respondents indicating that they received no training in dealing with emotional clients (113/361; 31.3%), sedation protocols for euthanasia (107/361; 29.6%), or managing compassion fatigue (132/361; 36.6%). Most respondents (268/361; 74.2%) received no formal training in euthanasia after graduation and learned from experience or discussions with colleagues. Providing animals and owners with a good experience during the euthanasia process was highlighted as important for managing compassion fatigue.

CONCLUSIONS

Euthanasia is a common procedure in companion animal practice and there is considerable variation in how veterinarians approach both the technical and non-technical elements. Training provided during veterinary school was generally considered below satisfactory, particularly regarding managing compassion fatigue and clients' emotional needs.

CLINICAL RELEVANCE

Providing veterinarians with additional training on adapting their euthanasia protocols to different clinical scenarios may improve the experience for patients, owners and veterinary staff.

The use of intrarenal injection of sodium pentobarbital for euthanasia in cats

OBJECTIVE

To determine whether intrarenal injection of sodium pentobarbital is a viable method for euthanasia in anesthetized client-owned cats and assess potential factors associated with time to cardiopulmonary arrest (TCPA) for such treated cats.

ANIMALS

131 client-owned cats.

PROCEDURES

In this retrospective study, client-owned cats presented for euthanasia between March 1, 2009, and January 15, 2010, were evaluated by veterinarians to determine suitability of intrarenal injection versus other methods of euthanasia. Cats included were anesthetized and then received 6 mL of sodium pentobarbital (390 mg/mL) by intrarenal injection. Results for TCPA were compared for cats grouped on the basis of variables of interest.

RESULTS

131 cats were included, of which 74 (79%) had a TCPA < 1 minute and 28 (21%) had a TCPA between 1.5 and 8 minutes after intrarenal injection. Most (124/131 [95%]) cats had no observable reaction to the intrarenal injection other than cardiopulmonary arrest. Median TCPA was longer for cats without (1 min; 25/131 [19%]) versus with (0 min; 106/131 [81%]) palpable kidney swelling upon injection.

CLINICAL RELEVANCE

The effects of intrarenal injection of sodium pentobarbital in cats of the present study were similar to those typically observed with IV administration of euthanasia solution. When this intrarenal injection method is used, cardiopulmonary arrest with few agonal reactions can be expected to occur quickly in most patients. The intrarenal injection method is suited for euthanasia of anesthetized cats with easily located kidneys when IV access may be difficult.

The Gift: Ethically Indicated Euthanasia in Companion Animal Practice

The majority of companion animals seen by veterinary practitioners will die by euthanasia. Yet euthanasia can be a source of moral stress for veterinary team members, even when ethically indicated. In this discussion, I explore when euthanasia is ethically indicated and discuss the potential impact of ethically indicated euthanasia on veterinary team members. In particular, I challenge the analogy that the veterinarian performing ethically indicated euthanasia is akin to an executioner, arguing that this analogy is both inappropriate and potentially harmful. Finally, I discuss how we can support ourselves and our colleagues in relation to euthanasia, so we can attend to and maximise the welfare of our patients at the end of their lives.