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Wednesday, August 3, 2016

Does Euthanasia Burn?

Lisa sends in the following scenario.

My 8 yr. old male Shih Tzu suffered from seizures.  In the last 3 years, we tried many drugs, including the standard protocol of phenobarbital and K bro. He ended up having a toxic type of reaction to the K Bro.  We tried Keppra  but the seizures kept on coming, and then finally moved to phenobarbital once again, along with Zonisamide.  We thought we found the perfect dosage, and we had mild seizures usually about 1 a month.  Nothing like the full blown grand mal seizures we had experienced before.

Unfortunately, he began having break through seizures, with his last session of 10 seizures in 2 days.  He also began pressing his head against the wall which was a new symptom.  We believed that perhaps he had a brain tumor.   

We decided to put him down since the seizures seemingly were becoming uncontrollable and would not respond to diazepam shots when he had the last 2 seizures. 

I asked the vet before the procedure if he needed a sedative as they did with our lab, as her euthanasia was a 2 shot process.

With our little Buddy, he put a catheter in him and told me he didn’t need the extra sedative and that it would take effect in 20 to 30 seconds.  I was holding him underneath his ribcage with his head on my shoulder, face was away from me.  My husband had the bottom half of his torso.  While he was passing, he began to breathe hard and deep, and took 4.5 deep, deep breaths.  He was also very hot to touch under his rib cage. 

My question is: Did this burn as it was going through his system?  Did it paralyze him?  Because I just have this strong feeling that a sedative type of solution wouldn’t cause the burning or hot sensation that I felt.  His heart also SPED UP before it stopped.  I feel haunted that maybe it burned but he was in pain for about 40 seconds but that he couldn’t move.  Any insight you could give would be helpful.   
Euthanasia solution is essentially anesthesia.  Other drugs within that same category used to be used (at a much lower dose) to induce anesthesia.  Nowadays we have much safer induction agents so we don't use these drugs anymore.  But what happens during anesthesia and euthanasia has many similarities.

When used appropriately, euthanasia solution first induced unconsciousness similar to inducing anesthesia.  The brain activity decreases before anything else happens, and I've been in situations where the pet needed a higher than expected dose, but they weren't conscious while we were giving more.  As the drug works through the system the brain activity continues to decrease and eventually completely stops.  Once that happens the heart no longer receives signals to contact and will also stop but the animal isn't aware of this.  Essentially the patient falls asleep, and then continues to get deeper and deeper until all body functions cease.  Since the first thing that happens is unconsciousness they are not aware of the rest.  At no point should an animal be paralyzed but conscious during euthanasia.

Deep, hard breathing is normal in the last moments of life, and represents a change in the function of the respiratory and cardiovascular systems.  Sometimes you can even see a deep "gasp" or "breath" after death, due to the diaphragm and other muscles continuing to have involuntary contractions.

The heart wouldn't speed up in the last moments of life, at least not in my experience.  However, the heart may temporarily "flutter" and have arrhythmias.  This could be potentially interpreted as "fast", even though it really isn't.  What is more likely to have happened is a condition called atrial fibrillation, where the atria (the top chambers of the heart) are spasming and contracting in a rapid, abnormal pattern.  The heart has two sets of pace makers that can stimulate contraction and beating when the brain isn't sending the right signals.  During death and with these drugs you can get a temporary arrhythmia due to the abnormal electrical signals in the body.

Again, the animal is aware of none of these things happening.  They are unconscious while the body is shutting down.

I have never experienced or heard of a sudden heat or warming during euthanasia, and I have performed this service on many, many dogs, cats, and other animals over my career (19 years as of this writing).  I have no explanation for that phenomenon, but it's not typical and I would think that it wasn't a true burning sensation.

Many vets will use sedation prior to euthanasia, truly inducing unconsciousness before giving the euthanasia drug.  If the pet is relatively easy to handle I've never seen a need for sedation.  The vast majority of animals I've euthanized have quietly passed away in less than 30 seconds.  I don't think there is anything wrong with giving a sedative, but I also don't think it's usually necessary and would never criticize a vet for choosing not to use it.

Lisa, I'm sorry that this seemed to be difficult for you and that you lost your friend.  Try and take comfort that I don't think he felt anything during this process, and it sounds like it was actually a peaceful passing.