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 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: Milo the nauseous dog

Milo, a 13-year-old MC, 22kg, mixed breed with age-related changes, is being euthanized at home due to old age and inappetence. Upon arrival, the veterinarian and assisting technician discover that Milo has lost his appetite and has been drooling a lot. The owners have seen him vomit at least once a day for the past week. Milo appears lethargic and uninterested in his surroundings, and euthanasia is agreed upon as the best course of action given the circumstances. Once the consent form is signed, the veterinarian describes the euthanasia process while the technician gives a subcutaneous sedative injection (xylazine and butorphanol) to help Milo rest before the euthanasia medication is given. Within 5 minutes after receiving the sedative, sleepy Milo becomes agitated and wants to leave the area. He is allowed to walk to the corner of the room, where he vomits and becomes very ataxic. The owners help him back to where the veterinarian and technician are gathered, where Milo lays down and appears more comfortable as he welcomes sleep. After a few more minutes, Milo is sleeping, and the technician places an intravenous catheter in the cephalic vein. In his dehydrated state, the technician’s preferred back leg lateral saphenous vein is hard to locate. A few moments of privacy are given to the family; then Milo is euthanized without further complication.

Discussion Questions

1. Milo has been vomiting daily and is already nauseous upon the veterinary team’s arrival. What do the owners need to know about the likelihood of more vomiting during pet euthanasia?
2. Sedative drugs have the potential to worsen nausea in a sick pet. What drugs should be avoided?
3. Milo walks to the corner of the room to vomit and then becomes ataxic. What can be done to support him better?

CAETA Euthanasia Case Suggestions

1. Owners are often concerned about vomiting, especially in the home setting. Vomit is unpleasant to deal with and can lead to owner stress. Milo’s family is electing euthanasia in part due to his vomiting and would likely not want it to happen again. They will benefit from knowing that Milo may still be nauseous during the euthanasia process, especially until he is in deep sleep. The veterinary team can offer information such as, “Milo has been vomiting regularly for a few days. It’s possible he will still feel nauseous when the sedative is given, but once sleeping, he will be much more comfortable,” or “If Milo gives us cues that his tummy is upset, we will help him through it. He’s in good hands with us.”
2. Some drugs cause nausea more than others. The main culprits are alpha-2 agonist drugs like xylazine, which was part of Milo’s pre-euthanasia sedation protocol. Other alpha-2 drugs include dexmedetomidine, medetomidine, and detomidine, however these tend to cause less vomiting than xylazine. Butorphanol was also given, but it’s less of a concern. Adding in acepromazine might have helped reduce the nausea. Acepromazine has antiemetic effects because it interacts with central dopaminergic receptors in the chemoreceptor trigger zone. In Milo’s case, it would have been best to avoid xylazine altogether and perhaps reach for an anesthetic protocol with a dissociative drug like ketamine or tiletamine. In his weakened and dehydrated state, a dissociative drug would also help maintain cardiac output and likely keep the veins easier to find; plus it would decrease the odds of vomiting.
3. When a sedated pet suddenly gets up to move away from the family, they usually feel uncomfortable about something, e.g., nausea or the urge to potty. It is common for nauseous animals to leave the immediate area to find somewhere else to get sick. Milo moving away from everyone to vomit is a normal reaction. The risk is that in his sedated, weakened state, Milo will struggle to walk and could collapse. The veterinarian and technician can support Milo by keeping him close so they can catch vomit in a pee pad or towel and then invite him to lie right back down to sleep. This avoids his ataxic, wobbly gait as he tries to figure out where to be. Once a nauseous animal vomits, they generally feel much better and can succumb fully to the effects of the sedative or anesthetic drugs. It was wise for the veterinary team to still offer privacy to the family before proceeding with euthanasia.

This case highlights the following Essential Components: O=Offer privacy before and after death, S=Safe space to gather, A=Avoid pain and anxiety, U=Use pre-euthanasia sedation/anesthesia, and N=Narrate the process. These examples are just a few of the ways euthanasia can be enhanced. Consider what else might be done to ease the client’s emotional burden and support the patient’s needs for a gentle death. The Companion Animal Euthanasia Training Academy is here to elevate your euthanasia expertise.