Table 7.
Drugs used for procedural sedation
| Sedative | Dose (mg/kg) | Route(s)* | Comments | References |
|---|---|---|---|---|
| Opioids | ||||
| Butorphanol † | 0.2–0.5 | IM, IV | ||
| Methadone | 0.05–0.6 | IM, IV, OTM | ||
| Morphine | 0.05–0.3 | IM, IV | Not recommended for use as a sole agent | |
| Hydromorphone | 0.05–0.1 | IM, IV | Higher doses are more likely to produce dysphoria | |
| Buprenorphine | 0.005–0.04 | IM, IV, OTM | ||
| Alpha2-adrenergic agonists | Emesis is common with administration of all alpha(α&x41;2- adrenergic agonists | |||
| Dexmedetomidine | 0.0025–0.04 | IM, IV | Preferred over other α2-adrenergic agonists if available | |
| Medetomidine | 0.01–0.04 | IM, IV | ||
| Xylazine | 0.1–1 | IM, IV | ||
| Others | ||||
| Tiletamine/ zolazepam | 2–3 | IM, IV, SC | IV will produce profound sedation/anesthesia; IM is preferred. Better sedation achieved in combination with opioid ± α2-adrenergic agonist | 60 |
| Alfaxalone | 2–3 | IM, IV, SC | IV doses as low as 0.5 mg/kg may provide significant sedation | |
| Combination examples ‡ | ||||
|
Opioid
+ dexmedetomidine |
0.0025–0.005 | IM, IV | 61 | |
|
Opioid
+ alfaxalone |
2–3 | IM, IV | ||
|
Opioid
+ dexmedetomidine + ketamine |
0.0025–0.005
2–3 |
IM, IV | If the opioid and the dexmedetomidine are reversed there will be minimal residual effect with the low dose of ketamine | 62 |
|
Opioid
+ acepromazine |
0.05–0.1 | IM, IV | ||
|
Opioid
+ dexmedetomidine + midazolam |
0.0025–0.005
0.05–0.2 |
IM, IV | Each of these drugs is reversible if it is necessary to remove the sedative effects | 63 |
|
Opioid
+ dexmedetomidine + alfaxalone |
0.0025–0.005
1–2 |
IM, IV | The high end of the dose range may anesthetize the cat | 64 |
|
Alfaxalone
+ dexmedetomidine |
1–2
0.0025–0.005 |
IM, IV | ||
*
Note: subcutaneous administration results in unpredictable uptake and effect, and some opioids given by this route produce more nausea and vomiting than when given by the IV or IM route
†
Generally provides better quality of sedation than other opioids when used as a sole agent
‡
This is not a complete list of all possible combinations, but rather a series of examples of commonly used drug combinations. Doses and individual drugs will need to be tailored to the patient’s and clinician’s needs
IM = intramuscular; IV = intravenous; OTM = oral transmucosal – under the tongue or buccally (place in the cheek pouch); SC = subcutaneous