Each pet is very different. Each pet's needs are individual and should be individually evaluated in regards to the need of pre-medications. The general description of how the procedure is performed is discussed on the Overview section and on the Understanding Euthanasia section.
I strongly believe in taking an approach that will consider the individual pet in front of me and his or her special circumstances. I do not believe in taking the same approach straight across the board in a robotic manner.
Therefore, the euthanasia process may differ from individual to individual. It is my role to make this process as painless and stress free as possible, but there are conditions that may make this a challenge. In a lot of cases, for dogs, particularly larger breeds and calm dogs, it is less stressful to simply have the IV catheter placed without any pre-medications. The only discomfort the IV catheter placement will usually cause is simply a little prick. It usually takes only a few seconds.
The advantage of having the IV catheter placed with no prior injections is that there will be only one needle and the injections given thereafter, since they will be given IV, will cause no pain and no discomfort at all and all the pet will experience is the sensation of falling asleep as if you were going to the hospital for a procedure and had to be put under anesthesia. You can barely count backwards from 10 to 7 and you are sleeping...
However, there are factors that may make the placement of the IV catheter more challenging and more difficult for the pet. Therefore, in some cases, the use of a sedative may make things easier on your pet. With the use of the heavy sedative, your pet will be, for all intents and purposes, unconscious and out of pain, although he or she may not loose blinking reflexes and may have an occasional swallow.
The advantage of the pre-euthanasia injection is that it requires minimal restraint and very little time to administer the injection under the skin and that the rest of the procedure, including the placement of the IV catheter, will be done with the pet practically out of consciousness.
The disadvantage is that there will be more than one needle prick and that some of the products given may cause a slight burning or pinching sensation at the injection site. Some pets will experience a greater or lesser degree of discomfort upon the administration of such injections. Usually, the discomfort of this injection will be minimal. Unfortunately, some pets who have a lesser pain threshold may cry. Also, some pets, like cancer patients or pets with neurologic disorders may react differently to medication and to pain.
In addition, the sedative takes some time to take into effect. This will cause your pet to experience a gradual onset of a heavy drugged feeling and in some cases, the pet may attempt to "fight off" the sensation of the induced sedation/drugged sensation. In some cases, this is preferable to putting the pet through the restraint needed to the placement of the I.V.; in some cases, it is a completely unnecessary additional step and avoiding the sedative will be less stressful to the pet.
Circumstances when using a sedative is preferable:
1. When the pet experiences anxiety at being approached by a stranger or at having his or her leg touched. The most evident example of this is encountered in fractious cats.
2. When the pet's level of pain is such that having to move him or her in a position that will allow the placement of the IV catheter will cause too much pain. Examples of this are spinal pain, or diseases causing hyperesthesia (the exacerbation of pain).
3. When the condition of the pet causes excessive dehydration, emaciation or poor perfusion (poor circulation) which may make it difficult to find a vein and which may subject your pet to more than one prick of the needle.
4. When the pet's condition causes him or her anxiety and restlessness and when he or she is not able to rest in a lying down position comfortably.
5. Cats ALWAYS do better with the pre-euthanasia sedation and in some cases, it is even better to administer the sedative in 2 separate injections except in some rare cases where the pet's condition is so advanced that he or she is already semi-conscious. Also, small dogs who tend to be more sensitive such as poodles, yorkies, maltese, etc... generally do better with a sedative despite the fact that the sedative injection itself can cause them some, usually minimal, discomfort.
Other than that, it is usually preferable to limit the needles to simple placement of the IV catheter. The main question to answer is: which will cause the pet the least discomfort? The restraint needed to place the IV catheter or the discomfort related to injecting the sedative?
Sedative can cause a variety of adverse effects. And although in most cases, those adverse effects are not encountered and pets will fall asleep peacefully and within a few minutes, there is not a single sedative which works predictably and reliably in 100% of cases and which never produces adverse physical or mental effects. Some of the possible adverse effects of sedatives are: mental disorientation, salivation, nausea, vomiting, irregular breathing, respiratory collapse, termors ("twitches"), seizures, loss of blood pressure (leading to difficult or impossible IV placement, which may require an alternate euthanasia technique administered painlessly internally), restlessness and excitability, etc... It is also possible that some pets are less sensitive to the sedative and may need 2 or 3 sedative injections before they finally fall asleep.
Another factor to consider is the mental disorientation that accompanies the sedative. The sedative takes anywhere between 2 minutes and 20 minutes to take into effect depending on individual sensitivity to sedatives and the condition of internal organs. During the period of time elapsing between the injection and the time when the sedative has taken full effect, pets may experience greater or lesser mental disorientation and discomfort (you may have experienced this if you have ever received a sedative). The reactions vary. Most pets appear peaceful, but some don't like the sensation during the period of time between the injection and the time when they are fully under the effect of the sedative, regardless of the kind of drug used. Occasionally, there may be an excitatory phase which can last a few minutes before the full effect of the sedative has been achieved. This excitatory phase can be distressing to watch as they may get disoriented and restless. Once the drug has taken full effect, the pet will be sleeping, peaceful and for all intents and purposes, out of consciousness and out of pain. It is impossible to predict which pet will experience an adverse reaction to the sedative.
We will seek your opinion on this matter, but if you are not sure, you can rely on our experience in evaluating the situation and your pet's condition, level of discomfort and level of anxiety and to take the best approach with will cause your pet the least discomfort and stress. It can happen that the doctor may think the pet will be fine without sedative and that after attempting to place the IV catheter, will realize that the pet will be better off with the sedative. In this case, at the slightest sign of discomfort on the part of the pet or at the first indication that the IV will be difficult to place, the doctor will stop the procedure and will administer a sedative prior to continuing.
Please remember that although our experience in these matter is great and our success in making this difficult moment peaceful and painless for your pet, some factors can be impossible to predict and your pet may have an adverse reaction. We do all we can to avoid this and to choose the best approach for your baby.