CAETA Euthanasia Case: Elvis the aggressive dog

The Companion Animal Euthanasia Training Academy (CAETA) invites you to consider the following fictional euthanasia case and reflect on how to proceed. After reviewing the case, read the questions and consider your answers before continuing on to CAETA’s suggestions. This case is designed to test your knowledge of companion animal euthanasia and be a conversation starter among your veterinary team. Case outcomes are enhanced when following CAETA’s 14 Essential Components of Good Euthanasia.

Euthanasia Case: Elvis the aggressive dog

Elvis, a 6-year-old, MC, 50kg German Shepherd, has human-directed aggression. He has lived with the same family since he was 6 months old and has always been extra protective of the home and his owners, but for the past 2 months, it has been getting worse. He recently bit a teenager skateboarding past the house, causing enough damage to require stitches. The owners (husband and wife with two sons, ages 10 and 12) have elected euthanasia with their regular veterinarian at their home, following the mandatory rabies quarantine period. Because there is an established relationship with a veterinarian, Elvis is prescribed 30mg/kg of gabapentin for sedation to be given 1 hour before the appointment in the hopes it will relax him for safer handling. The veterinarian arrives at the home and learns that Elvis is wide awake and barking excitedly. He is large and the family is worried he may try to bite the veterinarian. Everyone agrees it is still best to proceed. The veterinarian has brought a large muzzle and shows the wife how to place it securely over Elvis’ nose. Elvis is unhappy with the restraint and successfully lunges away each time the wife tries. The husband and wife use a large folded card table to move Elvis into the corner of the room, and while held in place, the veterinarian quickly gives him an intramuscular injection in the thigh with sedative drugs. Elvis is very unhappy and tries to run out of the room but the husband holds him close with a collar and leash. The two sons are quietly sitting on the couch, unsure what to do or how to feel. After 15 minutes, Elvis is calm enough for the veterinarian to give another intramuscular injection of an anesthetic drug to induce unconsciousness. The now sleeping Elvis is euthanized using intravenous pentobarbital without further issue or safety concerns.

Discussion Questions

1. The veterinarian has prescribed gabapentin as a sedative. Was this the best choice?
2. It was decided that Elvis should be euthanized even though he was wide awake, anxious, and unable to muzzle. What other options were there to increase safety for both Elvis and the people around him?
3. The two sons were unsure how to react to the struggle they saw Elvis experiencing. How can the veterinarian (and veterinary team) support their emotional needs?

CAETA Euthanasia Case Suggestions

1. Gabapentin at high doses can cause sedation and is often used for aggressive euthanasia cases, however a dose of 30mg/kg given to a strong, healthy dog is likely not enough to cause significant relaxation. CAETA recommends giving closer to 60mg/kg, plus layering on additional drugs to induce deeper sleep. This additional blog on oral pre-visit pharmaceuticals details other drug recommendations like phenobarbital, detomidine, and trazadone, including a modified Chill Protocol for euthanasia cases.
2. While it is understandable to proceed with euthanasia rather than risk another bite event, Elvis did experience considerable stress in his final moments. Ideally, the veterinarian and family are able to wait one more day so stronger sedative drugs can be given 2-3 hours in advance to deepen relaxation. This way restraint is unnecessary or at least greatly reduced. If trying again another day was impossible, perhaps trying a bit more to successfully place the muzzle would help. The card table was an acceptable tool in a pinch and did keep Elvis’ handlers safe. If he did bite someone during the appointment, his body would have to be submitted for rabies testing and that would have been unfortunate. It’s worth noting that Elvis took a long time to sedate following the intramuscular injection. While we are not told which types of drugs he was given, aggressive patients should be given anesthetic drugs like ketamine or tiletamine to induce rapid unconsciousness and prevent any further chance of personal injury.
3. Behavior euthanasia is hard on everyone. It feels like a lose-lose-lose situation. Veterinary teams can empathize with all family members and show compassion toward the situation. The young boys have grown up with Elvis and therefore his death is a memorable event. Everything possible should be done to prevent drama and keep the appointment gentle and peaceful. The more preplanning that can be done to ensure this, the better for everyone, including Elvis.

This case highlights the importance of safety during companion animal euthanasia, especially following a recent bite incident. Consider what else might be done to ease the situation for both patient and client. Behavior euthanasias are challenging and can lead to feelings of guilt, regret, confusion, and fear. You are encouraged to discuss this case with your team. The Companion Animal Euthanasia Training Academy is here to elevate your euthanasia expertise related to communication, technique, and business.