A comparative study between integrative practices and preappointement gabapentin on serum cortisol in cats

Clinical appointment generates stress in feline patients, influencing the frequency of veterinary care with the species. The purpose of this study was to assess serum cortisol in cats submitted to oral gabapentin and integrative practices during clinical care. Twenty cats were evaluated in three clinical appointments, one week apart. All cats were submitted to treatments: placebo (PL), gabapentin (GA), and integrative practices (IP) (music therapy, pheromone therapy, and chromotherapy). GA and PL were administered by the owners 90 min before transportation to the veterinary teaching hospital, and IP were applied 30 min before clinical care. Cats were physically examined at all timepoints, and blood samples were collected for cortisol measurement. Serum cortisol levels ranged from 0.49 µg/dL to 17.99 µg/dL. Mean cortisol concentrations when cats received PL (7.6 µg/dL) were higher than when cats received GA (4.9 µg/dL) and IP (4.1 µg/dL). There was a statistical difference in cortisol levels when cats receiving PL and GA were compared (p = 0.03) and between PL and IP (p = 0.005). The study showed that feline serum cortisol levels were lower when cats received the treatments to IP (integrative practices) and GA (gabapentin), demonstrating that these are applicable methods for reducing stress of feline patients in clinical evaluation.

Influence of gabapentin on the degree of sedation, physiological variables and propofol dosage in cats premedicated with acepromazine and methadone: a randomized, prospective, blinded, clinical study

This study evaluated the influence of gabapentin on sedation, propofol dosage, and physiological variables in cats premedicated with acepromazine and methadone. Thirty-four cats were randomly assigned to receive 100 mg of oral gabapentin (Gabapentin group) or placebo (Control group) 100 min before intramuscular premedication with acepromazine (0.05 mg/kg) plus methadone (0.3 mg/kg). Variables recorded included sedation, using the Dynamic Interactive Visual Analog Scale (DIVAS, range 0-100 mm) and a Numeric Descriptive Scale (NDS, range 0-14), heart rate, respiratory rate and Doppler systolic arterial pressure (SAP). All variables were measured before (T0), 100 min after administration of gabapentin or placebo (T1), and 30 min after premedication (T2). Physiological variables were also recorded after anesthetic induction with propofol (T3). At T2, NDS scores were higher in Gabapentin than the Control group [median (interquartile range): 4 (2-5) versus 2 (1-4), p = 0.028], whereas DIVAS scores were not significantly different [Control: 9 (4-13); Gabapentin: 12 (5-32)]. Despite the significant difference between groups in NDS scores, overall sedation scores were mild at T1 and T2 regardless of gabapentin administration. The propofol dosage did not differ between groups. The most concerning adverse effect was arterial hypotension (SAP < 90 mmHg), recorded only at T3 in 71% of cats in the Control group and 100% in the Gabapentin group, without significant difference between groups. Administration of gabapentin before premedication with acepromazine and methadone in healthy cats did not result in a clinically significant influence on sedation levels, physiological variables, or propofol dosage required for anesthesia induction.

Assessment of the effect of gabapentin on blood pressure in cats with and without chronic kidney disease

OBJECTIVES

The aim of the present study was to assess the effect of gabapentin on blood pressure (BP) in cats with and without chronic kidney disease (CKD).

METHODS

A randomized, blinded, placebo-controlled crossover study was performed. A total of 29 cats were included: 13 cats with stable CKD (IRIS stage 2-4) and 16 apparently healthy cats (serum creatinine <1.6 mg/dl and urine specific gravity >1.035). The cats were evaluated twice, approximately 1 week apart, and BP (Doppler sphygmomanometry) was obtained 3 h after cats received either a single dose of gabapentin 10mg/kg PO or placebo. For each cat, BP readings were obtained at each visit using the same Doppler and sphygmomanometer unit, and the same cat holder and Doppler operator, in the same location.

RESULTS

After administration of a single dose of gabapentin (10 mg/kg PO), BP was significantly lower (median 122 mmHg, range 82-170) than after administration of the placebo (median 150 mmHg, range 102-191; P = 0.001). In the CKD subgroup, BP was significantly lower after administration of gabapentin (median 129 mmHg, range 96-170) than after administration of the placebo (median 155 mmHg, range 102-191; P = 0.008). In the healthy cat subgroup, BP was significantly lower after administration of gabapentin (median 121 mmHg, range 82-139) than after administration of the placebo (median 137 mmHg, range 102-177; P = 0.002). The median change in BP was -12 mmHg (range -95 to 10) for healthy cats and -12 mmHg (range -43 to 21) for cats with CKD (no significant difference between subgroups).

CONCLUSIONS AND RELEVANCE

Gabapentin may decrease arterial BP in cats with and without CKD and these findings should be taken into account when gabapentin is administered to patients in which measurement of BP is needed.

Neuropathic pain in cats: Mechanisms and multimodal management

PRACTICAL RELEVANCE

Chronic pain is a significant welfare concern in cats, and neuropathic pain, which arises from aberrant processing of sensory signals within the nervous system, is a subcategory of this type of pain. To comprehend this condition and how multimodal pharmacotherapy plays a central role in alleviating discomfort, it is crucial to delve into the anatomy of nociception and pain perception. In addition, there is an intricate interplay between emotional health and chronic pain in cats, and understanding and addressing the emotional factors that contribute to pain perception, and vice versa, is essential for comprehensive care.Clinical approach:Neuropathic pain is suspected if there is abnormal sensation in the area of the distribution of pain, together with a positive response to trial treatment with drugs effective for neuropathic pain. Ideally, this clinical suspicion would be supported by confirmation of a lesion at this neurolocalisation using diagnostic modalities such as MRI and neuroelectrophysiology. Alternatively, there may be a history of known trauma at that site. A variety of therapies, including analgesic, anti-inflammatory and adjuvant drugs, and neuromodulation (eg, TENS or acupuncture), can be employed to address different facets of pain pathways.Aim:This review article, aimed at primary care/ general practitioners, focuses on the identification and management of neuropathic pain in cats. Three case vignettes are included and a structured treatment algorithm is presented to guide veterinarians in tailoring interventions.Evidence base:The review draws on current literature, where available, along with the author's extensive experience and research.

Cat owners do not provide more reliable weight estimates for cats compared with veterinary professionals in an emergency setting

OBJECTIVES

The aim of the present study was to assess the accuracy of weight estimation in cats provided by pet owners, veterinary technicians, house officers (interns and residents) and attending clinicians in an emergency room (ER). An additional objective was to determine whether carrying the cat contributed to a more accurate weight estimate.

METHODS

A total of 72 cats presented to an ER and were enrolled in the study. Pet owners, veterinary technicians, house officers and attending clinicians were asked to record the cats' estimated weights on individual data collection cards. The actual weights of the cats were then obtained and compared with participants' estimations.

RESULTS

There were no significant differences between weight estimates provided by pet owners, veterinary technicians, house officers and attending clinicians. Similarly, neither the length of experience of the veterinary staff nor carrying the cat had an effect on the provision of a more accurate weight estimate.

CONCLUSIONS AND RELEVANCE

Pet owners are no better at weight estimation of cats in the ER setting compared with veterinary professionals. Carrying the cat did not improve the accuracy of weight estimation among veterinary professionals. The mean cat weight of 4.9 kg could be used as an average cat weight in an emergency situation for an adult cat.

2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats

PRACTICAL RELEVANCE

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and are effective for the management of pain in cats. These Guidelines will support veterinarians in decision-making around prescribing NSAIDs in situations of chronic pain, to minimise adverse effects and optimise pain management. Information is provided on mechanism of action, indications for use, screening prior to prescription, use in the presence of comorbidities, monitoring of efficacy, and avoidance and management of adverse effects.

CLINICAL CHALLENGES

The cat's unique metabolism should be considered when prescribing any medications, including NSAIDs. Chronic pain may be challenging to detect in this species and comorbidities, particularly chronic kidney disease, are common in senior cats. Management of chronic pain may be complicated by prescription of other drugs with the potential for interactions with NSAIDs.

EVIDENCE BASE

These Guidelines have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM) and American Association of Feline Practitioners (AAFP). Information is based on the available literature, expert opinion and the panel members' experience.

Skin Disease and Behavior Changes in the Cat

The health of the skin and coat of a cat is connected to the behavioral health of the animal. Stressed animals can cause lesions to their skin and coat such as alopecia, ulcers, and self-mutilation. On the other hand, localized or systemic health problems can cause stress, or pain, and therefore can increase overgrooming and poor skin health. When treating overgrooming and related skin lesions, all the physical and behavioral causes must be addressed through a multimodal approach.

A Comparison of the Intrarectal and Intramuscular Effects of a Dexmedetomidine, Ketamine and Midazolam Mixture on Tear Production in Cats: A Randomized Controlled Trial

Cats are often easily stressed and uncooperative. The use of sedative agents in the feline species is widely used to perform even minor clinical and diagnostic procedures. The aim of this study is to assess the impact on tear film production of the intrarectal route (IR) administration of a mixture of dexmedetomidine, ketamine and midazolam in comparison with the intramuscular (IM) one. A group of twenty cats were involved in a randomized and blinded clinical trial. A clinical and ophthalmological examination was conducted on the cats. The IR group received dexmedetomidine 0.003 mg kg-1, ketamine 4 mg kg-1 and midazolam 0.4 mg kg-1; the IM group received dexmedetomidine 0.003 mg kg-1, ketamine 2 mg kg-1 and midazolam 0.2 mg kg-1. A Shirmer tear test I (STT- I) was conducted 1 h before sedation and 2', 10', 20', 30', 40', and 80' post drug administration. The reaction to STT-I administration was also evaluated. The IM group has a lower mean tear production than the IR group for all time points evaluated. Cats in the IM group showed less reaction to STT-I administration. This study may suggest that the effect of sedative agents administered by the IR route has a lower incidence on tear production than the IM one. The use of eye lubricant is recommended in any case.

Effects of gabapentin on intraocular pressure, tear production and horizontal pupil diameter in New Zealand White rabbits

BACKGROUND

This study aimed to investigate the effects of gabapentin on various ocular parameters in New Zealand White rabbits.

METHODS

A randomised, placebo-controlled crossover study design was employed. Eight New Zealand White rabbits were randomly assigned to receive either oral gabapentin at a dosage of 15 mg/kg or an oral placebo, with a 1-week washout period between treatments. Intraocular pressure, tear production and horizontal pupil diameter were measured at baseline (T0) and at 30, 60, 90, 120, 180, 240 and 360 minutes after drug administration. Physiological and behavioural changes were also recorded for both treatments following drug administration.

RESULTS

The administration of gabapentin did not have any significant effects on the ocular parameters measured in this study. However, the rabbits exhibited some muscle relaxation with partially closed eyes during handling, and they were slightly easier to remove from the cage when treated with gabapentin compared to the placebo treatment.

LIMITATIONS

In this study, the ocular effects of gabapentin were assessed in only a small number of healthy rabbits. These effects may differ in rabbits with pre-existing eye conditions or in those receiving other medications.

CONCLUSIONS

Our findings suggest that gabapentin treatment does not have a significant impact on intraocular pressure, tear production or horizontal pupil diameter in rabbits.

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

We sought to document the contemporary feline euthanasia practices among Australian veterinarians and determine the factors associated with the administration of a premedication or sedation prior to euthanasia. Australian veterinarians who had euthanised at least one cat during the previous 12 months were invited to participate in an anonymous online survey. From 615 valid responses, 585 respondents (95.1%) had euthanised at least one cat in the last 12 months, of which 462 respondents (75.1%) had performed an emergency euthanasia. Intravenous (IV) injection (n = 536, 91.6%) of pentobarbitone sodium (n = 584, 99.8%) was the predominant primary method. Premedication or sedation was administered to cats by 415/585 (71.0%) and 242/462 (52.4%) of respondents in non-emergency and emergency euthanasia, respectively. In a multivariable logistic regression analysis, for non-emergency euthanasia, being female and working in a metropolitan area were significant predictors for administering a premedication or sedation (p < 0.001 and p = 0.037, respectively). For emergency euthanasia, working in an 'other' type of practice was a significant predictor for administering a premedication or sedation (p < 0.001). Australian veterinarians vary in their approach to feline euthanasia. There is scope for refinement of euthanasia techniques to maximise the welfare of cats, their owners or guardians, and veterinary team members.

Pharmacokinetic, sedative, and physiological effects of oral compounded formulations of trazodone alone or in combination with gabapentin in male cats

Trazodone and gabapentin are common oral sedatives in cats, used alone or combined, but no pharmacokinetic studies exist for trazodone in this species. The objective of this study was to determine the pharmacokinetics of oral trazodone (T) alone, or in combination with gabapentin (G) in healthy cats. Cats (n = 6) were randomly allocated to receive T (3 mg/kg) intravenously (IV), T (5 mg/kg) orally (PO), or T (5 mg/kg) and G (10 mg/kg) PO with a 1-week washout period between treatments. Heart rate, respiratory rate, indirect blood pressure, and level of sedation were assessed, and venous blood samples were collected serially over 24 h. Analysis of plasma trazodone concentration was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Oral T administration resulted in a bioavailability of 54.9(7-96)%, and 17.2(11-25)% when administered with G. Tmax 0.17 (0.17-0.5) and 0.17 (0.17-0.75) h; Cmax 1.67 ± 0.91 and 1.22 ± 0.54 μg/mL, AUC 5.23 (2.0-18.76) and 2.37 (1.17-7.80) h*μg/mL; T1/2 5.12 ± 2.56 and 4.71 ± 1.07 h; for T and TG, respectively. Sedation was significant when compared to baseline in all groups from 20 or 45 min to 8 h indicating some lag between peak plasma concentration and sedative effects. Physiological variables remained within normal limits. This study concludes that oral trazodone is rapidly absorbed in healthy cats. Addition of gabapentin did not result in more profound sedation, showing no clinical advantage of combining these drugs in this study population.

2023 AAFP/IAAHPC feline hospice and palliative care guidelines

The '2023 AAFP/IAAHPC Feline Hospice and Palliative Care Guidelines' are authored by a Task Force of experts in feline hospice and palliative care convened by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. They emphasize the specialized communication skills and ethical considerations that are associated with feline hospice and palliative care, with references to other feline practice guidelines for a more complete discussion of specific diseases, feline pain management best practices and cat friendly interactions. A comprehensive, multi-step hospice consultation allows for tailoring the approach to both the cat and the family involved in the care. The consultation includes establishing 'budgets of care', a concept that greatly influences what can be done for the individual cat. The Guidelines acknowledge that each cat and caregiver will be different in this regard; and establishing what is reasonable, practical and ethical for the individual cat and caregiver is important. A further concept of the 'care unit' is introduced, which is extrapolated from human hospice and palliative care, and encourages and empowers the caregiver to become a part of the cat's care every step of the way. Ethical considerations include a decision-making framework. The importance of comfort care is emphasized, and the latest information available about how to assess the quality of a cat's life is reviewed. Emotional health is as equally important as physical health. Hence, it is fundamental to recognize that compromised physical health, with pain and/or illness, impairs emotional health. A limited discussion on euthanasia is included, referring to the AAFP's End of Life Educational Toolkit for recommendations to help the caregiver and the veterinary professional ensure a peaceful passing and transition - one that reflects the best interests of the individual cat and caregiver.

Effect of gabapentin on ambulatory, direct, systemic arterial blood pressure in apparently healthy cats in the at-home and in-clinic environments

OBJECTIVES

Situational increases in blood pressure (BP) frequently confound the accurate diagnosis of pathological systemic hypertension in cats. The objective of this study was to investigate the effect of gabapentin on direct, ambulatory systolic arterial BP (SBP) in cats in at-home and in-clinic environments.

METHODS

Six adult purpose-bred cats with surgically implanted femoral artery telemetric BP-sensing catheters were administered 100 mg of gabapentin or a placebo orally in two randomized, masked, crossover study phases. In the first, direct BP was measured continuously in undisturbed cats for 24 h before (at-home baseline) and 4 h after administration of study drug. The mean SBP after administration of the drug was compared between treatments. In the second study period, cats were administered gabapentin or placebo 90 mins before transport to a clinic, where direct BP was measured continuously during a simulated veterinary visit that included an indirect BP measurement session. Changes in mean direct SBP relative to the 24-h at-home pre-treatment period were calculated for each of one waiting room and two examination-room periods, and compared between treatments. Concurrent in-clinic direct and indirect SBP measurements were compared within-cat. Data were compared using linear mixed models.

RESULTS

Direct SBP data from one cat were excluded due to implant failure. There were no differences in at-home or in-clinic SBP between treatment groups, with large inter-individual variability. Cats in both treatment groups experienced in-clinic increases in direct SBP relative to at-home baseline (range 11-50 and 10-52 mmHg in placebo- and gabapentin-treated cats, respectively). Across all visits, direct SBP was 15.6 mmHg higher than indirect SBP (P <0.001). No effects of treatment on difference between direct and indirect SBP were identified.

CONCLUSIONS AND RELEVANCE

Significant effects of gabapentin on direct SBP were not identified, though a type II error is possible. Situational increases cannot be excluded in gabapentin-treated cats with high SBP.

Gabapentin: Clinical Use and Pharmacokinetics in Dogs, Cats, and Horses

Gabapentin is an anticonvulsant drug, which presents an established clinical efficacy in human patients for the management of refractory partial seizures, secondarily generalized tonic-clonic seizures, and for the control of chronic neuropathic pain. Gabapentin was synthesized as a structural analogue of the inhibitory neurotransmitter GABA, with GABA-mimetic effects, able to cross the blood-brain barrier. In veterinary medicine, is extra-label used in combination with other treatments to control seizures when other drugs are no longer effective or become toxic or for neuropathic pain treatment and anxiety. This review aimed to clarify gabapentin use and pharmacokinetic aspects to promote conscious use in dogs, cats, and horses. In dogs, gabapentin was beneficial in the treatment of epilepsy, as well as chronic, neuropathic, and post-operative pain, as well as anxiety. In cats, it showed efficacy in post-ovariohysterectomy-related pain and in anxiety management. In horses, gabapentin has been administered as an analgesic for chronic pain management. In conclusion, when used in combination with other drugs, gabapentin can be considered an interesting therapeutic option for the treatment of neuropathic diseases and analgesia in postoperative and chronic pain. However, despite its beneficial use in different clinical settings, further trials and pharmacokinetic studies are needed for the definition of an effective dosage regimen through proper pharmacokinetic/pharmacodynamic correlation in dogs, cats, and horses.

Validation of Plateletworks ADP for the ProCyte Dx analyzer

BACKGROUND

Platelet function testing in cats allows determination of clopidogrel effect. Plateletworks assesses aggregation based on decreasing platelet counts on hematology analyzers in response to agonists. It has not been validated for the IDEXX ProCyte Dx analyzer. Ideal time to perform analysis and the utility of other platelet parameters have not been fully assessed.

OBJECTIVES

To validate Plateletworks ADP on the ProCyte Dx, to investigate the utility of various platelet parameters using Plateletworks ADP, and determine the ideal time to perform analysis.

ANIMALS

Twenty healthy cats recruited from the general population used for transference of reference intervals to a new analyzer, and 10 cats receiving clopidogrel to determine clopidogrel effect.

METHODS

Plateletworks ADP using the ProCyte Dx and ADVIA 2120i analyzer was run simultaneously in both healthy cats and cats receiving clopidogrel, and CBC results at different timepoints were compared between analyzers.

RESULTS

Aggregation was significantly different (P < .001) between analyzers. Cohen's kappa showed almost perfect agreement for determination of clopidogrel effect, and the area under the curve of the receiver operating characteristic was 1.0. Lower limits of the aggregation reference interval in healthy cats were 28.8% on the ProCyte Dx and 12.5% on the ADVIA 2120i. Coefficients of variation for platelet parameters were not different between analyzers. No significant changes in mean platelet volume, plateletcrit, large platelets, and mean platelet component were identified. No significant change in aggregation was observed within the first hour after phlebotomy.

CONCLUSIONS AND CLINICAL IMPORTANCE

Our study validated the Plateletworks ADP system on the ProCyte Dx analyzer. Samples may be analyzed up to 1 h after collection.

Behavioral and physiologic effects of a single dose of oral gabapentin in rabbits (Oryctolagus cuniculus)

Stress in rabbits (Oryctolagus cuniculus) may influence veterinarians' ability to assess their health and can lead to complications such as gastrointestinal hypomotility and poor anesthetic outcomes. Gabapentin has been used as an anxiolytic in various species, but little information is available on its use in rabbits. To assess the effect of gabapentin on stress in rabbits, 5 female and 3 male New Zealand white rabbits, aged 8-12 months, weighing 3-4.5 kg, were administered a single dose (25 mg/kg) of oral compounded gabapentin. Effects on individual behaviors and selected physiologic parameters were assessed by a blinded observer using a human intruder test and tractability score (summed total 0-8, most to least tractable). Heart and respiratory rate, rectal temperature, body weight, and fecal output were also recorded. Baseline measurements for each rabbit were assessed immediately prior to gabapentin administration, and at 1, 2, and 4 hours post-administration. With this method rabbits acted as their own concurrent control group. Rabbits were assessed at 7 AM, 11 AM, and 3 PM. Data were analyzed as continuous, binary, and continuous nonparametric (P ≤ .05). No significant differences in physiologic parameters were observed between baseline and the post-administration timepoints. Fecal output was reduced similar to baseline measurements. Behaviors pressing down decreased (at 2 and 4 hours; P = .05 and P = .013, respectively) and approaching human increased (at 2 hours; P = .022) post-gabapentin compared to baseline. Tractability scores were improved at the 2-hour timepoint compared to baseline (Friedman P = .0461; Wilcoxon P = .0413). These results suggest gabapentin 25 mg/kg orally decreased reactivity with a peak effect at 2 hours, without significant effects on measured physiologic parameters. Oral gabapentin in rabbits should be considered to reduce stress in the presence of humans and to facilitate handling.

Effect of oral administration of gabapentin on the minimum alveolar concentration of isoflurane in cats

Objective

To determine if oral gabapentin decreases the minimum alveolar concentration (MAC) of isoflurane in cats.

Study design

Prospective, randomized, blinded, crossover, and experimental study.

Animals

A total of six healthy adult cats (three male, three female) aged 18-42 months, weighing 3.31 ± 0.26 kg.

Methods

Cats were randomly given oral gabapentin (100 mg cat^-1) or placebo 2 h before starting MAC determination, with the crossover treatment given at least 7 days apart. Anesthesia was induced and maintained with isoflurane in oxygen. Isoflurane MAC was determined in duplicate using an iterative bracketing technique and tail clamp method. Hemodynamic and other vital variables were recorded at each stable isoflurane concentration and were compared between gabapentin and placebo treatments at lowest end-tidal isoflurane concentration when cats did not respond to tail clamping. A paired t-test was used to compare normally distributed data, and a Wilcoxon signed-rank test was applied for non-normally distributed data. Significance was set at p < 0.05. Data are mean ± standard deviation.

Results

Isoflurane MAC in the gabapentin treatment was 1.02 ± 0.11%, which was significantly lower than that in the placebo treatment (1.49 ± 0.12%; p < 0.001), decreasing by 31.58 ± 6.94%. No significant differences were found in cardiovascular and other vital variables between treatments.

Conclusion and clinical relevance

Oral administration of gabapentin 2 h before starting MAC determination had a significant isoflurane MAC-sparing effect in cats with no observed hemodynamic benefit.

Does preappointment gabapentin affect neurological examination findings? A prospective, randomized and blinded study in healthy cats

OBJECTIVES

The aim of this study was to evaluate the influence of a preappointment oral dose of gabapentin on the neurological examination of cats.

METHODS

A prospective, randomized and blinded clinical trial was conducted in 35 client-owned healthy cats. Cats were scheduled for two appointments and randomly assigned to receive either a placebo or a 100 mg gabapentin capsule prior to the second veterinary visit. A neurological examination was performed during each visit, and the results were compared between groups. Normal/abnormal response rates for each test were based on the number of cats that allowed the test to be performed.

RESULTS

Gabapentin was administered to 17 cats. Gait and postural reactions were significantly affected in the gabapentin group. Comparing the gabapentin with the placebo groups, proprioceptive ataxia was identified in 4/17 (23.5%) vs 0/18 cats (P = 0.0288); paw placement deficits were seen in 10/11 (90.9%) vs 1/4 (25%) cats; table tactile placement deficits were identified in 13/17 (76.5%) vs 0/18 cats (P <0.0001); hopping deficits were seen in 5/17 (29.4%) vs 0/16 cats (P = 0.0185); and abnormalities on wheelbarrowing and extensor postural thrust were reported in 5/17 (29.4%) vs 0/18 cats (P = 0.0129). These results had no correlation with age or dose/kg received. No significant difference was noted in the assessment of level and content of consciousness, posture, cranial nerves and spinal nerves. No significant differences were noted in test compliance or examination duration.

CONCLUSIONS AND RELEVANCE

Gabapentin significantly altered gait analyses and postural reactions in this group of healthy cats. The administration of gabapentin could lead to false-positive results and, possibly, an incorrect identification of neurological lesions. In contrast, gabapentin did not impair the assessment of cranial nerves and spinal reflexes, which can be assessed in patients receiving the drug.

Pregabalin Alleviates Anxiety and Fear in Cats during Transportation and Veterinary Visits-A Clinical Field Study

Cats frequently suffer from anxiety related to travel and veterinary visits. One sequela is avoidance of veterinary visits and lack of adequate veterinary care. The objective of this study was to test clinical efficacy and safety of a novel formulation of a pregabalin 50 mg/mL oral solution for alleviation of anxiety and fear in cats during transport and veterinary visits. A total of 209 client-owned cats were given either a flavored pregabalin oral solution at the dosage of 5 mg/kg (n = 108) or an identical placebo (n = 101) approximately 90 min before placing them into the carrier and transporting them in a car for at least 20 min to a veterinary clinic. The treatment effect using a 5-point numerical rating scale was evaluated during transportation by the owner and during clinical examination by the veterinarian, both blinded to the treatment. In addition, to verify the owner assessment, an external expert blinded to the treatment and owner assessment evaluated the transportation video recordings using the same rating scale as the owner. Pregabalin 5 mg/kg statistically significantly decreased both travel- (p < 0.01) and veterinary-visit- (p < 0.01) related anxiety compared to the placebo. The external expert's evaluation was in agreement with the owners' assessment confirming the treatment effect during transportation (p < 0.01). Treatment was well tolerated with only a few cats showing transient slight incoordination and tiredness. The flavored oral solution formulation with a small dosing volume of 0.1 mL/kg was found by the owners to be user-friendly and was well-accepted by the cats. This study demonstrated that a single oral dosage of the novel pregabalin oral solution alleviates anxiety and fear related to transportation and veterinary visits in cats, thus providing practical aid for both owners and veterinarians to enable cat-friendly handling and improving the welfare of cats in situations they often perceive as very stressful.

Human-directed aggression and pica in a 1-year-old cat, which worsened following international relocation

Case summary

A 14-month-old female spayed Arabian Mau cat was presented for preparation for international air travel and relocation. It was also showing aggressive behaviours towards its owners and visitors to the home, with daily episodes of jumping at, scratching and biting the owners' hands and legs. In addition, the cat was chewing on and ingesting wool and fabric items. Diagnoses of aggression occurring as misplaced play/predatory behaviour, fear-based aggression towards visitors and pica were made, and recommendations were given for both the behavioural presentations as well as to prepare for the family's relocation to a new country and home. These recommendations included the use of long-acting psychotropic medications, which were declined at the time. After arrival in the new home, the cat's aggression and pica worsened, so the owners requested a follow-up appointment. At this point, the selective serotonin reuptake inhibitor (SSRI) fluoxetine was initiated and after 6 weeks of medication, the owners reported a significant improvement in all behavioural signs.

Relevance and novel information

There is limited published information on the development and/or worsening of behaviour problems after stressful or traumatic events, such as international relocation. Furthermore, the management of concurrent behavioural presentations, such as, in this case, human-directed aggression and pica, can be challenging. This case provides an example of how this may be achieved. Finally, this case shows how the use of long-acting psychotropic medication, such as the SSRI fluoxetine, can be important and effective in managing feline behaviour problems.

Feline Stress Management During air Travel: A Multimodal Approach

PRACTICAL RELEVANCE

More cats are travelling by air every year; however, air travel involves several common causes of stress for cats, such as environmental changes and a lack of control and predictability. The use of a multimodal stress management protocol for all stages of the relocation process, including appropriate and effective anxiolytic medication where necessary, is therefore important in order to safeguard the cat's welfare while travelling.

CLINICAL CHALLENGES

Cats may be presented to veterinarians for the purpose of preparing them and/or their documentation for air travel. Maintaining and protecting a cat's physical, mental and emotional health in a stressful environment, while subjected to likely unfamiliar sights, noises, smells and the movement of the aircraft, and additionally dealing with international legislation, regulations and documents, can pose a complex challenge to veterinarians.

AIMS

This review describes the importance of stress management during air travel for cats, aims to raise awareness about the often poorly understood challenges involved, and outlines effective and airline-compliant stress management modalities. While the discussion is focused on air travel specifically, the stress management methods described can be applied to all types of longer distance travel, such as a long road trip or a ferry crossing, as well as a stay in a holiday home.

EVIDENCE BASE

There are currently no studies specifically on air travel in cats and, similarly, there are also limited data on air travel in other species. Many of the recommendations made in this review are therefore based on the authors' extensive experience of preparing pets for travel, supported by published data when available.

Happy cats: stress in cats and their carers associated with outpatient visits to the clinic

OBJECTIVES

The importance of the effects of stress on cats is well recognised, with visits to the veterinary clinic a common cause of stress. The aim of this study was to explore owners' experiences of stress, both for themselves and their cat, during veterinary visits, and to gather data on owners' perception of resources within the clinic to reduce stress in their cats.

METHODS

A questionnaire aimed at cat owners with recent experience of an outpatient visit to the veterinary clinic was developed and distributed. Questions covered demographics; their most recent veterinary visit; their general experience of visits over the past 3 years; measures taken by the clinic to reduce stress; and awareness of the Cat Friendly Clinic programme. There were various question types, with owners often asked to rate stress from 1 (least stressful) to 10 (most stressful).

RESULTS

A total of 277 respondents gave details about their experience of consultations over the past 3 years. Owners rated the stress of travelling to the clinic, other animals in the waiting room and the consultation itself (all median 6, interquartile range 4-8) as the most stressful elements. Most owners reported gentle methods of removing the cat from their carrier; however, almost a third (n = 81/263; 30.8%) had seen their cat scruffed during a consultation. Cat-only waiting rooms were viewed as the most effective measure to reduce stress in the clinic.

CONCLUSIONS AND RELEVANCE

Veterinary clinics are already taking steps to address stress in cats, and owners have a good awareness of stress in their cats. Future work should focus on trialling specific interventions to determine their effectiveness in reducing stress in feline patients, and measures currently perceived by owners to be highly effective, such as cat-only waiting rooms, should be used where feasible.

Serum concentrations of gabapentin in cats with chronic kidney disease

OBJECTIVES

The purpose of this study was to assess serum concentrations of gabapentin in cats with chronic kidney disease (CKD) vs clinically healthy cats.

METHODS

Five healthy cats were enrolled in a pharmacokinetic study. A single 20 mg/kg dose of gabapentin was administered orally and blood was obtained at 0, 0.25, 0.5, 1, 1.5, 2, 3, 4, 8, 12, 24 and 36 h via a jugular catheter. Serum gabapentin concentrations were measured using liquid chromatography coupled to tandem mass spectrometry. Non-compartmental pharmacokinetic analysis was performed. The same five healthy cats plus 25 cats with stable International Renal Interest Society stage 2 (n = 14) and 3 (n = 11) CKD were enrolled in a limited sampling study. Cats in both groups received a single 10 mg/kg dose of gabapentin, and serum gabapentin concentrations and compliance scores were obtained 3 and 8 h post-administration.

RESULTS

Cats with CKD had significantly higher dose-normalized serum gabapentin concentrations than normal cats at 3 h (P = 0.0012 CKD vs normal 10 mg/kg; P = 0.008 CKD vs normal 20 mg/kg) and 8 h (P <0.0001 CKD vs normal 10 mg/kg; P <0.0001 CKD vs normal 20 mg/kg). Both 3 and 8 h dose-normalized serum gabapentin concentrations were significantly correlated with serum creatinine (3 h: P = 0.03, r = 0.39; 8 h: P = 0.001, r = 0.57) and symmetric dimethylarginine (3 h: P = 0.03, r = 0.41; 8 h: P = 0.007, r = 0.48). There was a significant correlation between 3 h serum gabapentin concentrations and compliance scores (P = 0.0002, r = 0.68).

CONCLUSIONS AND RELEVANCE

Cats with CKD that received 10 mg/kg of gabapentin had significantly higher dose-normalized serum concentrations than normal cats that received 20 mg/kg, supporting the need to dose-reduce in this patient population.

Behavioral and cardiovascular effects of a single dose of gabapentin or melatonin in cats: a randomized, double-blind, placebo-controlled trial

OBJECTIVES

The aim of this study was to verify whether a single oral dose of gabapentin (100 mg) or melatonin (3 mg) given 60 mins before a cardiac evaluation would reduce anxiety without interfering with heart rate (HR), systemic blood pressure (SBP), electrocardiogram (ECG) and echocardiographic indexes.

METHODS

Seventy-five client-owned healthy cats underwent two sets of cardiac assessments 60 mins apart, randomly divided into gabapentin, melatonin and placebo groups. The interval between treatment and the second ECG and SBP measurement was 60 mins, and 70 mins for echocardiography. A compliance score (CS) classified the behavior, focusing on the ease of handling.

RESULTS

Most variables did not change between the examinations. The placebo group showed more significant changes (SBP, tricuspid annular plane systolic excursion, HR during echocardiography, aortic flow velocity, S' wave from lateral mitral annulus), but they were not considered to be hemodynamically relevant. Gabapentin and melatonin significantly increased the cats' compliance without interfering with cardiac assessment. Eight cats presented with mild sedation, seven after gabapentin and one after melatonin. No major side effects were observed.

CONCLUSIONS AND RELEVANCE

Gabapentin tranquilized the cats when it was given 60 mins prior to ECG and SBP measurement, and 70 mins prior to echocardiography, without interfering with systolic echocardiographic indexes. Melatonin also decreased the CS, but without sedation in most cases. The waiting period may have relaxed the cats in the placebo group, resulting in lower SBP measurements. However, this tranquility did not last as some echocardiographic changes signaled a sympathetic predominance.

Evaluation of the effects of gabapentin on the physiologic and echocardiographic variables of healthy cats: a prospective, randomized and blinded study

OBJECTIVES

The aim of this study was to evaluate, using echocardiography, the effects of oral administration of a single dose of gabapentin on the physiologic variables (heart rate [HR], respiratory rate [RR] and systolic blood pressure [SBP]) and systolic and diastolic cardiac function of healthy cats.

METHODS

This was a prospective, randomized and blinded study with 40 healthy cats aged between 6 months and 2 years. The cats' health status was assessed on the first appointment (T1) when they underwent a physical examination, complete blood count, biochemical profile, assessment of physiologic variables and echocardiogram. The echocardiogram was used to measure the left ventricle's (LV) internal diameter during systole and diastole, isovolumic relaxation time, transmitral flow, E-wave deceleration time and HR. The cats were randomly divided into two groups: (1) a treatment group with 20 cats that received a single oral dose of gabapentin (100 mg/cat); and (2) a control group with 20 cats that received a single oral dose of placebo. All variables of the physiologic and echocardiographic variables were re-evaluated 1-3 weeks after T1 (T2), 90 mins after medication or placebo administration.

RESULTS

There was no difference in the physiologic variables evaluated in both groups. The proportion of cats in the treatment group that had their ventricular filling waves fused on T1 but did not have them fused on T2 was significantly higher (45%) compared with cats in the control group (15%; P = 0.0384).

CONCLUSIONS AND RELEVANCE

There was no difference between the groups in regard to SBP, HR, RR and echocardiographic variables. Gabapentin improved evaluation of diastolic function on echocardiogram because it reduced the fusion of ventricular filling waves during the evaluation of the diastolic function of the LV. Gabapentin did not cause adverse effects on the cardiovascular hemodynamics of young healthy cats.

2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques

PRACTICAL RELEVANCE

The '2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques' (hereafter the 'Cat Friendly Veterinary Interaction Guidelines') support veterinary professionals with feline interactions and handling to reduce the impact of fear and other protective (negative) emotions, in so doing enhancing feline welfare and In implementing these Guidelines, team satisfaction and cat caregiver confidence in the veterinary team will increase as the result of efficient examinations, better experience, more reliable diagnostic testing and improved feline wellbeing. Veterinary professionals will learn the importance of understanding and appropriately responding to the current emotional state of the cat and tailoring each visit to the individual.

CLINICAL CHALLENGES

Cats have evolved with emotions and behaviors that are necessary for their survival as both a predator and prey species. A clinical setting and the required examinations and procedures to meet their physical health needs can result in behavioral responses to protective emotions. Cat friendly interactions require understanding, interpreting and appropriately responding to cats' emotional states and giving them a perceived sense of control while performing the required assessment.

EVIDENCE BASE

These Guidelines have been created by a Task Force of experts convened by the American Association of Feline Practitioners and the International Society of Feline Medicine, based on an extensive literature review and, where evidence is lacking, the authors' experience.

ENDORSEMENTS

These Guidelines have been endorsed by a number of groups and organizations, as detailed on page 1127 and at catvets.com/interactions and icatcare.org/cat-friendly-guidelines.

Beyond “Doing Better”: Ordinal Rating Scales to Monitor Behavioural Indicators of Well-Being in Cats

Safeguarding the well-being of cats is essential to the mission of any responsible animal shelter. Environmental enrichment and behaviour modification are often key to this goal. Measuring response to these interventions is essential to ensure strategies are successful. There are often many staff and volunteers involved in these efforts, and a lack of standardised language can make monitoring progress difficult. Ordinal rating scales of key behaviours can be a useful way to summarise observations and ensure that common language is used. However, it is crucial that these scales have good interobserver agreement and reliability, so operational definitions and training systems are important. This paper presents a method for evaluating four different expressions of cat welfare on a 0–5 scale: modified Fear, Anxiety, and Stress score; Response to Petting score; Participation in Play score; and Food Intake Summary score. All scales showed almost perfect average interobserver agreement (linear weighted κ) and excellent average interobserver reliability (interclass correlation coefficient). These scales may prove useful to other shelters, or any other environment where evaluating response to interventions is important to the welfare of cats, such as research facilities or home environments. The exceptional interobserver agreement and reliability of this study compared with some others highlights the importance of standardised training programs.

Comparison of Certain Intrarectal versus Intramuscular Pharmacodynamic Effects of Ketamine, Dexmedetomidine and Midazolam in Cats

The aim of this clinical trial was to evaluate the impacts of administration via the intrarectal route (IR) in cats on their heart and respiratory rates, blood pressure, body temperature, and sedation quality compared to the intramuscular route (IM). The intramuscular group (IMG) received 0.003 mg kg−1 dexmedetomidine, 2 mg kg−1 ketamine, and 0.2 mg kg−1 midazolam while the intrarectal group (IRG) protocol was 0.003 mg kg−1 dexmedetomidine, 4 mg kg−1 ketamine, and 0.4 mg kg−1 midazolam. Cardiorespiratory values, temperature, and sedation score were measured 2 min after administration and then every 5 min up to the 40th minute. Cats belonging to IRG reacted less strongly to the drug, as opposed to those receiving intramuscular administration (2/10 in IRG vs. 8/10 in IMG). Average time between drug administration and standing position was 44.9 ± 5.79 in IRG and 57 ± 9.88 min in IMG. In IRG, maintenance of SpO₂ values is >95% at each time point. Median and range peak of sedation {7 (5)} in IMG occurs at 20th, 25th, and 30th minutes post drug administration while was lower in IRG. Cardiorespiratory values were slightly lower in IMG than in IRG, but always constant in both treatments. Temperature did not differ between groups. At this dosage, although sedation score was higher in IMG, intrarectal route could be efficacious for performing minimally invasive clinical and diagnostic procedures in cats.

Gabapentin reduces stress and does not affect ocular parameters in clinically normal cats

OBJECTIVE

To describe the effects of gabapentin on ocular and behavioral parameters following oral administration in healthy cats.

MATERIALS AND METHODS

Masked, placebo-controlled, randomized crossover-design study. Ten young, healthy cats were scheduled for two veterinary visits 7 days apart and randomly assigned to receive a compounded capsule containing 100 mg of gabapentin or placebo (100 mg lactose powder) at the first visit and the opposite treatment at the second visit. Respiratory rate, heart rate, stress score, sedation score, compliance score, horizontal pupil diameter, intraocular pressure, and Schirmer tear test-1 were measured prior to and 1.5, 3, and 6 h following capsule administration. Stress score, sedation score, and compliance score were assigned based on established behavioral scales. Results of the two treatments were statistically compared with a p-value <0.05 considered significant.

RESULTS

Respiratory rate was significantly reduced at 1.5 (p = 0.049) and 3 (p = 0.03) hours following gabapentin administration. Stress score was significantly reduced at 1.5 (p = 0.01) hours following gabapentin administration. Sedation score was significantly increased at 1.5 (p = 0.015) and 3 (p = 0.03) hours following gabapentin administration. Gabapentin had no significant effect on heart rate, compliance score, or ocular values measured in this study.

CONCLUSIONS

Gabapentin reduces stress and increases sedation at 1.5 h after treatment, with no significant effect on horizontal pupil diameter, intraocular pressure or Schirmer tear test-1 results.

Sensory-Motor Perturbations in Larval Zebrafish (Danio rerio) Induced by Exposure to Low Levels of Neuroactive Micropollutants during Development

Due to increasing numbers of anthropogenic chemicals with unknown neurotoxic properties, there is an increasing need for a paradigm shift toward rapid and higher throughput behavioral bioassays. In this work, we demonstrate application of a purpose-built high throughput multidimensional behavioral test battery on larval stages of Danio rerio (zebrafish) at 5 days post fertilization (dpf). The automated battery comprised of the established spontaneous swimming (SS), simulated predator response (SPR), larval photomotor response (LPR) assays as well as a new thermotaxis (TX) assay. We applied the novel system to characterize environmentally relevant concentrations of emerging pharmaceutical micropollutants including anticonvulsants (gabapentin: 400 ng/L; carbamazepine: 3000 ng/L), inflammatory drugs (ibuprofen: 9800 ng/L), and antidepressants (fluoxetine: 300 ng/L; venlafaxine: 2200 ng/L). The successful integration of the thermal preference assay into a multidimensional behavioral test battery provided means to reveal ibuprofen-induced perturbations of thermal preference behaviors upon exposure during embryogenesis. Moreover, we discovered that photomotor responses in larval stages of fish are also altered by the as yet understudied anticonvulsant gabapentin. Collectively our results demonstrate the utility of high-throughput multidimensional behavioral ecotoxicity test batteries in prioritizing emerging risks associated with neuroactive drugs that can perturb neurodevelopment. Moreover, we showcase the added value of thermotaxis bioassays for preliminary screening of emerging contaminants.

Perception of stress in cats by German cat owners and influencing factors regarding veterinary care

OBJECTIVES

Visiting the veterinarian is generally perceived as a stressful situation for cats. Previous studies have shown that the perception of stress may influence cats' healthcare. In order to minimise stress in cats during the veterinary consultation, feline-friendly handling has gained importance and is increasingly being used. The aim of this study was to find out whether cats experience stress during a visit to the veterinarian (and, if so, to what extent), and which factors influence the perception of stress and whether feline-friendly handling techniques have an impact.

METHODS

An online survey was conducted among German cat owners. In total, 889 questionnaires were evaluated. The results were analysed with binary logistic regression and a χ² test. A principal component analysis was used to detect the main influencing factors on the perception of stress.

RESULTS

Most of the cats (88.7%, n = 732/825) were perceived as stressed during a veterinary consultation, while only about half of the owners (50.8%, n = 419/824) stated that they felt stressed themselves. The cat owners (n = 819) who perceived visiting the veterinarian as a stressful situation also described their cat as stressed significantly more often compared with owners who did not feel stressed (χ² = 101.113, P <0.001). The probability that owners experienced stress themselves was significantly increased if they perceived their cat to be stressed too (odds ratio 0.073, 95% confidence interval 0.016-0.328). One factor that influenced whether an owner was stressed was the stress behaviour of their cat (P <0.001). Furthermore a feline-friendly demeanour by the veterinarian led to less stress in the owners (P <0.001).

CONCLUSIONS AND RELEVANCE

The owner's stress influences the perception of their cat's stress. By adhering to feline-friendly handling guidelines, veterinarians can reduce owner stress associated with veterinary visits, thereby promoting optimal veterinary care and health for their feline patients.

Double-blind, placebo-controlled trial of venlafaxine to treat behavioural disorders in cats: a pilot study

OBJECTIVES

Venlafaxine, a specific inhibitor of both noradrenaline and serotonin, is commonly used in human medicine to treat depression, anxiety and social phobia. Its formulation in small granules renders it interesting to test on cats, which are usually reluctant to take medication. Venlafaxine was administered at 1 mg/kg for 60 days, using a double-blind, placebo-controlled protocol, to cats aged ⩾6 months exhibiting aggressiveness, fear or house-soiling.

METHODS

After one cat's withdrawal, 21 cats were included in the study: 11 in the venlafaxine group and 10 in the placebo group. Three consultations were conducted, on day 0, day 30 and day 60. Each visit consisted of (1) veterinarian- and owner-based scoring of the cat's behavioural improvement; (2) scoring of the cat's compliance with removal from its carrier and compliance with manipulation; and (3) owner scoring of the ease of administration and recording of the potential adverse effects of the treatment.

RESULTS

Improvement was significantly higher in the venlafaxine group; as early as day 30, according to the veterinarian scoring, and at day 60, according to both the veterinarian and owner scoring. In contrast, neither the removal nor the manipulation scores were significantly different between the two treatment groups. Venlafaxine seemed to improve all three studied signs, as early as day 30 for fear and aggressiveness, and at day 60 for house-soiling. The adverse effects of venlafaxine were limited to drowsiness in one cat. All cats tolerated the treatment well during the 60-day period.

CONCLUSIONS AND RELEVANCE

These results suggest that venlafaxine is efficient in treating several behavioural problems and is easy to administer. More studies should be conducted to explore its effects at different dosages on specific diagnoses.

Randomised clinical trial evaluating the effect of a single preappointment dose of gabapentin on signs of stress in hyperthyroid cats

Objectives

The aim of this study was to evaluate the efficacy of gabapentin as an anxiolytic in hyperthyroid cats.

Methods

Cats (n = 47) with confirmed hyperthyroidism were successfully enrolled. The cat owner allocated a temperament score and a transport stress score at their first visit. For the second visit the cat owner (blinded to treatment) administered either liquid gabapentin 20 mg/kg (n = 22) or an indistinguishable placebo solution (n = 25) 1 h prior to leaving home. A second transport score was allocated by the cat owner at this visit. Upon admission a compliance score was independently assigned by two veterinary nurses blinded to treatment. Excess blood from routine blood draw was analysed for gabapentin plasma concentration from cats in the gabapentin group.

Results

There were no significant differences in baseline transport score between groups (P = 0.13), but significant differences were noted in the second visit transport score between cats medicated with gabapentin compared with placebo (P = 0.018). Mean compliance scores were significantly different between cats in the treatment group compared with placebo (P = 0.019). Further sedation was required to complete the procedures in 24% of cats in the placebo group compared to 9% in the gabapentin group (P = 0.25). Mean plasma gabapentin concentrations were 10.1 mg/l (range 1.7–22.7) in the gabapentin group within a 1–3 h time frame post-administration.

Conclusions and relevance

Hyperthyroid cats medicated with 20 mg/kg gabapentin 1 h prior to leaving home were more relaxed during transport and more compliant with veterinary procedures than cats administered a placebo solution.

Effects of trazodone on behavioral and physiological signs of stress in dogs during veterinary visits: a randomized double-blind placebo-controlled crossover clinical trial

OBJECTIVE

To determine whether a single dose of trazodone administered to dogs before a veterinary visit reduced their behavioral and physiologic signs of stress and owners' stress during veterinary visits.

SAMPLE

20 dogs and their owners.

PROCEDURES

In this randomized double-blinded placebo-controlled crossover clinical trial, dogs with a history of anxiety during veterinary visits were scheduled for 2 veterinary visits 1 week apart and randomly assigned to receive a single oral dose of either trazodone (9 to 12 mg/kg) or a placebo 90 minutes before transport to the veterinary clinic for alternate visits between September 21 and November 3, 2019. For each visit, we collected and assessed owner-completed surveys of dog stress score (DSS) and owner stress score; various investigator-reported scores, including from video-recorded behavior analyses; and patient-related physiologic data.

RESULTS

Dogs treated with trazodone versus placebo had lower mean DSSs, assessed by owners for physical examination and assessed by video analysis for time spent in the examination room; lower mean SD of normal-to-normal intervals, root mean square of successive heartbeat interval difference, and respiratory rate; and higher mean heart rate. No meaningful differences were observed in other behavioral or physiologic outcomes, including serum cortisol concentrations.

CLINICAL RELEVANCE

A single dose of trazodone before transport reduced signs of stress during veterinary visits for dogs in the present study and may be useful as an anti-anxiety medication for similarly affected dogs, potentially resulting in higher-quality clinical examinations and improved patient welfare.

2022 AAHA Pain Management Guidelines for Dogs and Cats

These updated guidelines present a practical and logical approach to the assessment and management of acute and chronic pain in canine and feline patients. Recognizing pain is fundamental to successful treatment, and diagnostic guides and algorithms are included for assessment of both acute and chronic pain. Particularly for chronic pain, capturing owner evaluation is important, and pain-assessment instruments for pet owners are described. Expert consensus emphasizes proactive, preemptive pain management rather than a reactive, "damage control" approach. The guidelines discuss treatment options centered on preemptive, multimodal analgesic therapies. There is an extensive variety of pharmacologic and nonpharmacologic therapeutic options for the management of acute and chronic pain in cats and dogs. The guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

Pharmacokinetics and pharmacodynamics of repeat dosing of gabapentin in adult horses

Background

The repeated administration of high doses of gabapentin may provide better analgesia in horses than current clinical protocols.

Hypothesis and Objectives

Administration of gabapentin at 40 and 120 mg/kg PO q 12 h for 14 days will not alter serum biochemistry findings or cause adverse effects. Our objectives were to evaluate the effect of gabapentin on serum biochemistry, physical examination, and plasma pharmacokinetics of gabapentin.

Animals

Six healthy adult mares.

Methods

Horses received 40 and 120 mg/kg of gabapentin orally q 12 h for 14 days. Horses were examined and scored for ataxia and sedation daily. Serum biochemistry variables were analyzed before treatment and days 7 and 14 after gabapentin administration. Plasma disposition of gabapentin was evaluated after the first and last drug administration. Pharmacokinetic parameters were estimated using noncompartmental analysis.

Results

No changes occurred in physiologic or biochemical variables. Median (range) maximal plasma gabapentin concentrations (μg/mL) after the last dose (day 15) were 7.6 (6.2‐11) and 22 (14‐33) for 40 mg/kg and 120 mg/kg doses respectively. Maximal concentration of gabapentin was reached within 1 hour after drug administration. Repeated administration of gabapentin resulted in a median (range) area under the curve (AUC_{0‐12 hours}) last/first dose ratio of 1.5 (1.00‐2.63) and 2.92 (1.4‐3.8) for the 40 and 120 mg/kg regimens, respectively.

Conclusion and Clinical Importance

Our results suggest that horses tolerate gabapentin up to 120 mg/kg PO q 12 h for 14 days. The analgesic effect of the dosage regimens evaluated in our study warrants further research.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

PRACTICAL RELEVANCE

Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer.

CLINICAL CHALLENGES

Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management.

EVIDENCE BASE

These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors' experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.

Comparative Multimodal Palliative efficacy of gabapentin and tramadol By Using Two Pain Scoring Systems in Cats Undergoing Ovariohysterectomy

The analgesic efficacy of the gabapentin-tramadol combination was compared with meloxicam-tramadol and tramadol perioperative analgesic regimens in cats brought to the clinic for ovariohysterectomy. Thirty adult cats belonging to comparable demographics (age, body weight), were enrolled into a randomized, blinded study after due consent from their owners into four treatment groups. A Gabapentin-Tramadol group (GT-group, n = 10), Meloxicam-Tramadol group (MT-group, n = 10), and a Tramadol group (T-group, n = 10) were formed. Gabapentin capsules at 50 mg were administered orally 2 hours before surgery while the rest received a placebo dose. Tramadol (2 mg/kg, IM) and meloxicam at (0.2 mg/kg, SC) were injected immediately prior to anesthetic premedication. Anesthetic protocol involved premedication with ketamine and xylazine, while anesthesia was induced using propofol. Inhalant isoflurane anesthesia was used to maintain a surgical plane. GT group scored lower on IVAS as well as CPS than MT group, and T group for up to 8 hours after surgery. The mechanical nociceptive threshold remained higher (98±0) for up to 12 hours postoperatively a nd serum cortisol concentrations remained significantly lower during the 24hr period. The addition of gabapentin to the tramadol regimen significantly improved analgesia and mechanical nociceptive threshold than when used on its own.

Clinical evaluation of the effects of a single oral dose of gabapentin on fear-based aggressive behaviors in cats during veterinary examinations

OBJECTIVE

To investigate the effects of a single oral dose of gabapentin on fear-based aggressive behaviors (FABs) in cats during veterinary examinations.

ANIMALS

55 healthy pet cats (26 with and 29 without a history of FAB during veterinary visits [FAB and untreated control groups, respectively]).

PROCEDURES

A standardized 9-step clinical examination protocol (with patient compliance scored from 0 to 9 according to the highest completed step) was tested on untreated control group cats. The protocol was then used in a double-blind, randomized, placebo-controlled, crossover-design trial in which FAB-group cats received owner-administered gabapentin (100 or 200 mg/cat) or placebo capsules 2 hours before the first of 2 veterinary visits and received the alternate treatment before the second visit ≥ 1 day later. Ease of administration (scored from 1 [very difficult] to 4 [very easy]) and adverse effects were recorded. Compliance scores were compared between treatments for the FAB group and between FAB and untreated control groups. Changes in scores between treatments for the FAB group were used to investigate associations between selected variables and the outcome of interest.

RESULTS

FAB group compliance scores after gabapentin administration (median, 9; range, 0 to 9) were significantly higher than scores after placebo administration (median 0.5; range, 0 to 7) and did not differ from scores for the untreated control group. Owner scores indicated capsule administration was easy. Adverse effects (most commonly drowsiness, myorelaxation, and ataxia) resolved ≤ 10 hours after detection.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested oral administration of gabapentin to cats 2 hours before a veterinary visit can reduce FAB during physical examination, enabling more complete evaluation.

Hemodynamic, Echocardiographic, and Sedative Effects of Oral Gabapentin in Healthy Cats

The study objective was to evaluate sedative, hemodynamic, and echocardiographic effects of cats receiving single-dose, oral gabapentin. A prospective, double-blinded, placebo-controlled, crossover study was conducted with 10 client-owned cats. Vital parameters, physical exam, blood pressure, echocardiography, and sedation scoring were performed at each visit within 2 hr of receiving either a placebo or gabapentin capsule. Vital parameters, blood pressure recordings, and echocardiographic measurements were compared between baseline, gabapentin, and placebo; interobserver agreement for sedation scoring and correlation between variables were also evaluated. Seven of 10 cats exhibited mild sedation within 120 min after receiving gabapentin, and no adverse events occurred. Significant differences were detected with two-dimensional fractional shortening (P = .022), left ventricular internal diameter in systole using M-mode (P = .014), and left atrial volume (P < .0001). Interobserver agreement for sedation scoring was near-perfect (κ = 0.84). No significant correlation was found for gabapentin dosage and sedation score. Single-dose oral gabapentin is well tolerated in healthy cats and produces a modest decrease in several echocardiographic parameters of systolic function; however, all affected variables remained within established reference ranges. These results suggest gabapentin may be an appropriate sedative to administer before echocardiography in cats necessitating mild sedation.

Cognitive Dysfunction in Cats: Update on Neuropathological and Behavioural Changes Plus Clinical Management

Cognitive dysfunction syndrome (CDS) is an established condition in cats that shares many similarities with human Alzheimer's disease (AD), where cognitive decline ultimately results in dementia. Cats with CDS display behavioural abnormalities, including excessive Vocalisation, altered Interaction with owners (increased affection/attention), altered Sleep-wake cycles, House-soiling, Disorientation (spatial and/or temporal), alterations in Activity, Anxiety, and/or Learning/memory deficits (i.e., VISHDAAL). These cats develop neuropathologies, such as accumulation of β-amyloid and hyperphosphorylated tau deposits. Because of its similarities to those in the brains of people with cognitive impairment and AD, the domestic cat could be a natural model for human dementia studies. It is important to diagnose CDS promptly in cats, ruling out other causes for these behavioural changes, to provide effective management. Interventions include environmental enrichment (e.g., easy access to key resources, calming pheromones), dietary supplementations (e.g., Senilife, Aktivait for cats, SAMe), specific diets (e.g., containing antioxidants, medium-chain triglycerides) and, potentially, medication (e.g., selegiline or propentofylline). This article reviews the literature about CDS in cats, its causes, neuropathology, clinical signs, diagnosis and potential management options. By doing so, it furthers our understanding of this condition and allows improved health, welfare and quality of life of affected cats.