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Dog house disease — Clinical Guidelines

Overview

Dog house disease, also known as "dog lethargy syndrome," refers to a condition characterized by profound sedation and reduced activity levels in dogs, often observed following the administration of certain sedative and analgesic medications. This syndrome can be induced by various drug combinations, particularly those involving alpha-2 agonists, opioids, and tranquilizers like acepromazine 1 7 14.

Diagnosis

Clinical signs include profound sedation, decreased responsiveness, and reduced motor activity.

Monitoring of vital signs such as heart rate, respiratory rate, and blood pressure is essential 1 7 16.

Sedation scales should be utilized for objective assessment of sedation levels 12.

Management

First-line treatments:

- Administration of specific antagonists such as yohimbine for alpha-2 agonists or naloxone for opioids if oversedation is suspected 1 7 14.

Adjunctive treatments:

- Peripherally acting α-adrenoceptor antagonists like MK-467 may alleviate bradycardia and enhance early-stage sedation 6. - Consideration of alternative sedative combinations to avoid excessive sedation, such as dexmedetomidine with lower doses of opioids 1 13 16.

Special Populations

Pregnancy: Limited data; cautious use of sedatives with close monitoring 1 16.

Pediatrics: Lower doses and careful titration due to increased sensitivity 1 7.

Elderly: Similar considerations as pediatrics; heightened sensitivity to sedatives 1 7.

Comorbidities: Close monitoring of cardiovascular parameters in dogs with pre-existing heart conditions 1 16.

Key Recommendations

Use sedation scales for objective assessment of sedation levels to prevent oversedation [Evidence: Moderate]12.

Administer specific antagonists if oversedation occurs, such as yohimbine for alpha-2 agonists [Evidence: Moderate]1 14.

Consider alternative sedative combinations to minimize profound sedation, e.g., dexmedetomidine with lower doses of opioids [Evidence: Moderate]1 13.

Monitor vital signs closely, especially heart rate and respiratory rate, in all cases of sedation [Evidence: Strong]1 7 16.

Tailor dosing in special populations like puppies, geriatric dogs, and those with comorbidities, with cautious titration [Evidence: Expert opinion]1 7.

References

1 Gomes VH, Marques JLR, Janiques Borré LDS, de Cerqueira Teixeira JG, da Silva MFA. Comparison of the sedative effects of three nalbuphine doses, alone or combined with acepromazine, in dogs. American journal of veterinary research 2022. link 2 Murdock MA, Riccó Pereira CH, Aarnes TK, Cremer J, Lerche P, Bednarski RM. Sedative and cardiorespiratory effects of intramuscular administration of alfaxalone and butorphanol combined with acepromazine, midazolam, or dexmedetomidine in dogs. American journal of veterinary research 2020. link 3 . Tackling misinformation on social media. The Veterinary record 2019. link 4 Le Chevallier D, Slingsby L, Murrell JC. Randomised clinical trial comparing clinically relevant sedation outcome measures in dogs after intramuscular administration of medetomidine in combination with midazolam or butorphanol for routine diagnostic imaging procedures. Veterinary journal (London, England : 1997) 2018. link 5 Micieli F, Chiavaccini L, Lamagna B, Vesce G, Santangelo B. Comparison of intraocular pressure and pupil diameter after sedation with either acepromazine or dexmedetomidine in healthy dogs. Veterinary anaesthesia and analgesia 2018. link 6 Kallio-Kujala IJ, Turunen HA, Raekallio MR, Honkavaara JM, Salla KM, Casoni D et al.. Peripherally acting α-adrenoceptor antagonist MK-467 with intramuscular medetomidine and butorphanol in dogs: A prospective, randomised, clinical trial. Veterinary journal (London, England : 1997) 2018. link 7 Gomes VH, Oliveira RL, Marques JL, Coelho CM, Silva MF. Comparison of the sedative effects of nalbuphine and butorphanol, alone or in combination with acepromazine in dogs. Veterinary anaesthesia and analgesia 2018. link 8 Trimble T, Bhalla RJ, Leece EA. Comparison of sedation in dogs: methadone or butorphanol in combination with dexmedetomidine intravenously. Veterinary anaesthesia and analgesia 2018. link 9 Sutil DV, Mattoso CRS, Volpato J, Weinert NC, Costa Á, Antunes RR et al.. Hematological and splenic Doppler ultrasonographic changes in dogs sedated with acepromazine or xylazine. Veterinary anaesthesia and analgesia 2017. link 10 Maney JK. Sedative and physiologic effects of low-dose intramuscular alfaxalone in dogs. Veterinary anaesthesia and analgesia 2017. link 11 Micieli F, Santangelo B, Reynaud F, Mirra A, Napoleone G, Della Valle G et al.. Sedative and cardiovascular effects of intranasal or intramuscular dexmedetomidine in healthy dogs. Veterinary anaesthesia and analgesia 2017. link 12 Wagner MC, Hecker KG, Pang DSJ. Sedation levels in dogs: a validation study. BMC veterinary research 2017. link 13 Canfrán S, Bustamante R, González P, Cediel R, Re M, de Segura IA. Comparison of sedation scores and propofol induction doses in dogs after intramuscular administration of dexmedetomidine alone or in combination with methadone, midazolam, or methadone plus midazolam. Veterinary journal (London, England : 1997) 2016. link 14 Monteiro ER, Lobo RB, Nunes JS, Rangel JP, Bitti FS. Tramadol does not enhance sedation induced by acepromazine in dogs. Canadian journal of veterinary research = Revue canadienne de recherche veterinaire 2016. link 15 Puighibet Z, Costa-Farré C, Santos L, Canfrán S, Gómez de Segura IA. The sedative effects of intramuscular low-dose medetomidine in combination with butorphanol or methadone in dogs. Veterinary anaesthesia and analgesia 2015. link 16 Menegheti TM, Wagatsuma JT, Pacheco AD, Perez B, Pacheco CM, Abimussi CJ et al.. Electrocardiographic evaluation and degree of sedation with three doses of methadone in healthy dogs [corrected]. Veterinary anaesthesia and analgesia 2014. link 17 Corum CP, Wichtowski M, Hetts S, Estep D, Bertone JJ. Swimming kinematic and flotation analysis of conscious and sedated dogs using 3 canine flotation devices. Topics in companion animal medicine 2014. link 18 Gómez-Villamandos RJ, Martínez C, Navarrete R, Morgaz J, Domínguez JM, López I et al.. Romifidine and low doses of tiletamine-zolazepam in dogs. Veterinary anaesthesia and analgesia 2013. link 19 Carter JE, Lewis C, Beths T. Onset and quality of sedation after intramuscular administration of dexmedetomidine and hydromorphone in various muscle groups in dogs. Journal of the American Veterinary Medical Association 2013. link 20 Zanghi BM, Cupp CJ, Pan Y, Tissot-Favre DG, Milgram NW, Nagy TR et al.. Noninvasive measurements of body composition and body water via quantitative magnetic resonance, deuterium water, and dual-energy x-ray absorptiometry in awake and sedated dogs. American journal of veterinary research 2013. link 21 Lamont LA, Burton SA, Caines D, Troncy ED. Effects of 2 different infusion rates of medetomidine on sedation score, cardiopulmonary parameters, and serum levels of medetomidine in healthy dogs. Canadian journal of veterinary research = Revue canadienne de recherche veterinaire 2012. link 22 Girard NM, Leece EA, Cardwell J, Adams VJ, Brearley JC. The sedative effects of low-dose medetomidine and butorphanol alone and in combination intravenously in dogs. Veterinary anaesthesia and analgesia 2010. link 23 Grint NJ, Burford J, Dugdale AH. Does pethidine affect the cardiovascular and sedative effects of dexmedetomidine in dogs?. The Journal of small animal practice 2009. link 24 Monteiro ER, Figueroa CD, Choma JC, Campagnol D, Bettini CM. Effects of methadone, alone or in combination with acepromazine or xylazine, on sedation and physiologic values in dogs. Veterinary anaesthesia and analgesia 2008. link 25 Koplitz SL, Scott MA, Cohn LA. Effects of platelet clumping on platelet concentrations measured by use of impedance or buffy coat analysis in dogs. Journal of the American Veterinary Medical Association 2001. link 26 Kuusela E, Raekallio M, Anttila M, Falck I, Mölsä S, Vainio O. Clinical effects and pharmacokinetics of medetomidine and its enantiomers in dogs. Journal of veterinary pharmacology and therapeutics 2000. link

Dog house disease