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Feline Euthanasia 101 – Managing Myths & Misconceptions

Every so often I come across these odd news stories detailing strange tales of dogs and cats who somehow managed to cheat euthanasia. Like the Rottweiler who “awoke” and came wandering into the living room after being euthanized by his veterinarian in the garage. Then there’s the account of the homeless cat who survived not one but two trips to the carbon monoxide gas chamber before shelter workers decided that killing her wasn’t such a good idea.

Inevitably, these reports whip pet owners everywhere into a froth of well-justified righteous indignation coupled with understandable bewilderment: “How, exactly, can a veterinarian allow that to happen? How could they not know whether she’s dead or not? Could this happen to my pet?”

Such strong reactions help explain how these seemingly annual news events trigger not just the ire of the public, but discussions on the merits and pitfalls of various euthanasia methods too. Which, as you might expect, also raises the unavoidable misconceptions concerning the mechanics of euthanasia and how the drugs employed to bring it on actually work.

That’s why it behooves us veterinarians to always make plain the euthanasia methodology we intend to employ. Because when it comes to something as emotionally fraught as euthanasia, there’s no such thing as too much communication.

So at the risk of overloading you with information, here’s an explanation of the most common method of euthanasia private veterinarians employ in their practices with explanations about the drugs that are typically involved:
But before we go there, let me first explain the goal, as described by the American Veterinary Medical Association’s Guidelines For the Euthanasia of Animals (2013):

“When euthanasia is the preferred option, the technique employed should result in rapid loss of consciousness followed by cardiac or respiratory arrest and, ultimately, a loss of brain function. In addition, animal handling and the euthanasia technique should minimize distress experienced by the animal prior to loss of consciousness.”

The Two-Injection Method

With that in mind, the currently favored method of achieving this goal in veterinary private practice settings is the so-called “two-injection method.” In this approach, an initial injection goes either in the vein (intravenous) or in the muscle (intramuscular), to elicit extreme sedation. Once sedation is accomplished (typically rendering a pet both completely unresponsive and thoroughly insensate) a second drug is then administered (typically as an intravenous injection) to overdose the animal and achieve cardiopulmonary arrest.

Both injections are technically considered “overdoses” of drugs we either currently use or historically have used in veterinary practice for sedation, tranquilization, analgesia and/or anesthesia. But it’s important to note that not every veterinarian uses the same drugs in the same way at the same doses.

Indeed, while the two-injection method may be the modern gold standard approach to euthanasia, there’s a surprising degree of variability when it comes to the drugs employed in the process and it’s impossible to detail them all here.

Here is a brief run-down of the most common drugs we use, categorized by their use as first or second injection drugs.

First Injection

The goal: profound sedation or complete anesthesia with a minimum of pain or stress related to medical techniques or handling).

Common drugs used include:

Misconception alert: None of these drugs causes an “awake” form of paralysis you may have heard about. Many owners fear this but, rest assured, we are not merely rendering animals motionless with our choice of first injection drugs. Nothing less than a profound sedation with complete anesthesia is the goal of this stage.

Second Injection

The goal: cardiac arrest and respiratory arrest followed by a complete loss of brain function)

Sometimes, however, if the first injection is extremely effective (as it is designed to be), intracardiac (directly into the heart) injection is considered a humane alternative. This usually happens when the intravenous route becomes complicated by any condition that limits a veterinarian’s ready access to the veins. But here’s the thing: Intracardiac injections of drugs are painful and should NEVER be administered to an animal that is not anesthetized or verifiably unconscious.

An intraperitoneal injection (directly into the abdomen) of barbiturates in a conscious animal is, however, considered a humane method according to the AVMA’s guidelines. Nonetheless, it’s much less frequently undertaken than the intravenous route due to a) the long period of time before pets succumb and/or b) the disagreeable appearance of the process.

Whichever the approach, barbiturates, if dosed properly, lead irrevocably to death. Once the heart stops and respiration ceases, loss of brain function quickly follows. Owners nervous about this process who want to feel as certain as they can be that their pet has passed are always free to sit with their pets for a reassuring period of time.

I know this is a long post and you’ll no doubt have LOTS more questions but here’s hoping this post will at the very least help set your mind at ease about some of the medical issues you might not understand or may have misgivings about –– especially those that might naturally arise after hearing news reports about “incomplete” euthanasia.