December 18, 2017

Feline Euthanasia - Part 2: Clinical Considerations and Technical Recommendations

Whether the procedure is performed in the clinic or at home, the veterinary team should always have the cat’s mental health and physical comfort and the owner’s feelings top of mind.
By William Ray Folger, DVM, MS, DABVP (Feline Practice); Elizabeth Colleran, DVM, MS, DABVP (Feline Practice); Tina Han, DVM; and Elizabeth Strand, MSSW, PhD
A good death requires humane technique. If a cat’s life is to be taken, it should be done with the highest degree of respect and with a singular emphasis on making death as painless and stress-free as possible. The technique employed should result in rapid loss of consciousness followed quickly by cardiac and respiratory arrest and, ultimately, loss of brain function.

Preparations must be complete before the client and patient enter the room, and participants should be instructed to behave in a compassionate manner. Soft voices, slow and gentle movements, and an emphasis on the environment are paramount. The person assisting the doctor should know to leave the room as soon as his or her presence is no longer essential.

The Euthanasia Procedure
Intravenous (IV) administration of barbiturates, either alone or in combination with other drugs, is the preferred method of euthanasia, and sodium pentobarbital, which produces rapid death, is the preferred drug (Box).1-5 Premedication to provide anxiolysis and analgesia/anesthesia is recommended in all euthanasia procedures.

Many humane and relatively painless premedicants and premedicant/anesthetic combinations are available (Table). Choices should be based on staff training, knowledge, and experience with pharmaceuticals commonly used in the veterinary practice. When possible, premedications should be given subcutaneously to avoid discomfort. Diluting the drug with warm sterile water for injection can reduce distress.

If routes other than IV administration are necessary (eg, because a cat is very small, debilitated, or dehydrated), the cat should be fully unconscious or anesthetized. Pentobarbital and secobarbital do not cause tissue irritation, but pentobarbital combination products, such as pentobarbital/phenytoin (eg, Euthasol, Virbac), do. Intraperitoneal administration of a nonirritating barbiturate may be necessary or desirable under certain circumstances.

RELATED:
Recent data on 131 cats euthanized at home demonstrated that intrarenal administration of pentobarbital causes pain-free death very rapidly in the sedated cat.6 The average time to cardiopulmonary arrest was less than 1 minute, and 95% of cats had no observable reaction (agonal breathing, twitching) when 3 to 6 mL of euthanasia solution was given via a 1-inch, 18-gauge needle aimed at the renal cortex. Palpable kidney swelling was used as an indicator of correct administration, although this was not always present. Kidney size, patient weight, and hydration status had no impact on efficacy.6

In-Clinic Euthanasia
Client Communication
As discussed in Part 1 of this series, quality-of-life discussions should take place long before the decision to euthanize is made.7 Then, once the decision has been made, clients need to determine whether to be present for the entire procedure.

Owners who wish to be present should be asked whether they have ever witnessed euthanasia. If the answer is yes, then a brief description of what to expect may suffice. For clients who have never witnessed euthanasia, the veterinarian should detail the procedure in an empathetic manner.

Any potentially upsetting behavior by the cat, such as loss of bladder or bowel control, agonal breathing, or muscle fasciculations, should be described in advance and the owner assured that these signs do not indicate pain or discomfort. The length of time the procedure will take and the steps that will be taken should be described, emphasizing that the cat will be painless. The paramount message should always be that the heartbreaking decision to euthanize was made out of an unselfish and loving desire to prevent their beloved cat from further suffering.

The veterinary team may be the only support the owner has if friends and family do not understand the client’s depth of the attachment to the animal. Compassionate listening and reflecting back to owners an understanding of the intensity of their grief are critical to preserving the veterinarian–client relationship.

Procedure Location
The euthanasia location should be quiet, with good light- ing, adequate ventilation, and little traffic. All the necessary drugs and supplies should be assembled before the owner and pet arrive. During the time between sedative administration and injection of euthanasia solution, owners may welcome a few minutes alone to say goodbye. Their wishes should preempt any concerns about time or schedule. A sign or symbol in the treatment room indicating that a euthanasia is about to be performed can signal staff to maintain quiet and respect. Some practices light a candle in the waiting area to indicate that this procedure is taking place.



Reducing Anxiety and Fear
The anxiety experienced by cats and their owners when cats are taken into the treatment room, or “back” of the hospital, has been well described. At no other time is it more important to be aware of this than when euthanasia is about to be performed. Some things to consider:
  • Never take the cat from the owner.
  • Many of these cats suffer from multiple or chronic illnesses that may exacerbate the pain response (ie, allodynia, hyperalgesia). Therefore, if IV administration of the euthanasia solution is planned and an IV catheter is not already in place, venous access should be via syringe. IV catheter placement is unpleasant enough in healthy patients without the use of transdermal analgesia.


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