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 the veterinary team. Case outcomes are enhanced when following CAETA’s 14 Essential Components of Good Euthanasia.

Euthanasia Case: Rosie, the elderly rat

Rosie is a three-year-old, black-hooded rat who has been slowing down for the past month. She has had two seizure-like events in the past week and appears to have a grape-sized mass developing in her groin region. Rosie is brought to the hospital for euthanasia in a shoebox with air holes cut in the sides. She is being carried by her two adult owners, who have three other rats at home and adore Rosie as the favorite. They are led into the smallest exam room for the procedure. Rosie has a history of being difficult to handle by the veterinary team, and the owners are worried she will get away from them even in her weakened state. After completing paperwork, Rosie is lifted from the shoebox and placed on the owner’s lap. She is given an injection of pentobarbital sodium, a euthanasia solution, directly into her abdomen, which she initially seems to tolerate but then squirms to get away. Rosie falls on the floor but is quickly recovered and falls asleep almost immediately. The owners bring her up to the exam table with the veterinarian and they all watch as she takes her last breath. A little tuft of her fur is shaved and saved to take home.

Discussion Questions

1. Rosie is nervous about traveling to new places and can be difficult to handle. How can you reduce her stress while preventing escape?
2. You want Rosie to pass quickly with the least amount of drama. What drugs will you use?
3. The other three rats may need euthanasia someday. How do you modify rat euthanasia protocols today for future preparedness?

CAETA Euthanasia Case Suggestions

1. Rosie may be weakening and somewhat frail, but it sounds like she can still move quickly. We want to do everything we can to minimize her stress. Transporting her in a home cage with her familiar surroundings is ideal. If that’s not possible, she should be brought to the hospital in something larger than a shoebox that’s more difficult to climb out of and contains some of her usual bedding/smells. The goal is to keep her feeling safe and relaxed, prevent the risk of injury or escape, and make it easy for the veterinarian to handle her. It is difficult to give an injection in tight spaces and this may be why Rosie was placed on the owner’s lap for euthanasia solution administration. To further reduce stress, her transport carrier should have spaces for her to hide under if she chooses. If Rosie must be removed and placed on the exam table or owner’s lap, a thin towel or pillowcase can be used to swaddle her body. Better yet, keep her in the box she came in during initial drug administration.
2. Working with small species like Rosie can be challenging. While giving an intraperitoneal injection of pentobarbital euthanasia solution sounds easier than trying to find a vein to inject, it can still lead to patient discomfort. It’s advisable to start with pre-euthanasia anesthesia to induce unconsciousness in Rosie. Once she is unconscious, she will be pain and anxiety-free during all further handling, and an intraorgan pentobarbital injection can be given to shorten the time to death if desired. Oral drugs can be given first to avoid an injection (0.1ml tiletamine combined with 0.05ml pentobarbital, with a syringe tip dipped in syrup). If an injection has to be given, consider 0.15ml tiletamine with 0.01ml dexmedetomidine and 0.1ml acepromazine. To avoid the low pH of tiletamine, just the dexmedetomidine and acepromazine can be given to sedate, followed by the tiletamine to anesthetize. Some small mammals who are highly sensitive to needles can inhale isoflurane gas instead to induce unconsciousness. Once Rosie is unconscious, she can be given an injection of pentobarbital anywhere in her body with good blood perfusion. This includes the heart, liver, and kidney, although a skilled practitioner may be able to locate and inject a vein.
3. This family had a bit of a challenging time with Rosie’s death. The veterinary team has learned from this experience and is ready to improve things for the next three rats. Immediately following this appointment, the Euthanasia Training Manual should be reviewed and updated with what was learned. The best euthanasia protocols should be entered into the hospital’s manual, otherwise known as the Standard Operating Procedures (SOPs). Based on Rosie’s appointment, it is wise to include pre-planning recommendations such as keeping exotic pets in home cages or larger transport containers. Exotic pets should also receive pre-euthanasia anesthesia to render them unconscious quickly and smoothly. The preferred euthanasia techniques to include in the manual include intraorgan injections with the patient unconscious. The manual is to be reviewed by everyone on the team involved with pet euthanasia and updated as often as needed to keep current with modern best practices.

This case highlights the following Essential Components: S=Safe space to gather, A=Avoid pain and anxiety, U=Use pre-euthanasia sedation/anesthesia, and D=Deliver proper technique. 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.