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Handling, Restraint, and Preanesthetic Assessment

Graeme Doodnaught and Paulo Steagall

Université de Montréal, Saint-Hyacinthe, Canada

Key Points

• Behavioral considerations
• Handling methods and physical restraint
• Routes of drug administration
• Airway management
• Preanesthetic evaluation
• Mortality and morbidity in feline anesthesia

Introduction

The pet cat population has grown over the last few decades, as has our understanding of disease prevention and treatment in this species. Despite population growth, fewer cats visit a veterinary clinic on a regular basis when compared with dogs. Cat owners often avoid veterinary visits as transportation of the cat to the clinic may be stressful. Handling, appropriate physical examination, knowledge of behavior, and preanesthetic assessment are essential components of feline anesthesia and analgesia.

Box 1.1: Cat-friendly Techniques in Clinical Practice

Safe handling and cat-friendly practices minimize stress, fear, anxiety, and potential personnel injuries related to aggression. They are key components of veterinary care for the anesthetist and staff members.

A cat-friendly practice will provide an environment that reduces the stress of veterinary consultation and hospitalization. More information can be found at http://icatcare.org (June 24, 2017). These practices involve:

• A calm, safe, and quiet clinic with cat-designated areas or cat-only appointment times
• Gentle and efficient physical examination and treatment
• Client education on transporting the cat to and from the clinic
• Client communication about feline anesthesia and analgesia

Handling and Restraint

Each cat is unique and can exhibit a wide range of behaviors. Experienced handlers will often adapt their approach and handling technique to suit each patient. While there is no substitute for "experience", some principles exist to aid in the restraint of most cats. The mantras "go slow to go fast" and "less is more" are commonplace. Good feline handling revolves around the premise of de-escalation, where the handler avoids potential actions that may elevate a patient's stress. De-escalation minimizes noxious visual, auditory, and olfactory stimuli that could lead to avoidance or aggressive behavior. It should be noted that the major cause of defensive or aggressive behavior is fear. Cats have limited appeasement behaviors, making it difficult to calm them once they are distressed. Thus, avoiding these behavioral triggers is critical to success.

To facilitate handling throughout life, kittens should be encouraged to interact with people, animals, and new environments between 2 and 7 weeks of age. With all ages of cats, positive reinforcement techniques (e.g. rewarding with food, play, brushing) along with behavioral therapy in difficult individuals, help to reduce the stress and anxiety associated with veterinary visits.

Most cats in a calm environment will readily explore their surroundings. Anxious or fearful individuals will tend to remain within their carriers. The cat should be handled with patience and a positive attitude throughout the physical examination. Minimal restraint is required to perform a full physical examination in most cats. Gentle touch and petting around the head and neck are generally well tolerated, and allow for minor manipulations without the need for physical restraint (Figure 1.1a, b, c). Timid or fearful individuals who choose to remain in the carrier should be allowed to do so. The top of a carrier may be removed and an examination can be performed with the cat still inside (Box 1.2).

Box 1.2: Safe Handling in Feline Practice

Consider using top-opening carriers and baskets for transporting cats into the clinic. This allows for easy handling and provides a safe and secure environment.

Figure 1.1 A cat-friendly approach in a hospital setting. (a) This cat explores the examination room and its surroundings. (b) The handler gently pets the cat to control its movement without using forcible restraint. (c) Placing the hands under the chin allows for better control of the head and neck.

It is understandable that most medical procedures in cats require some level of restraint. This makes treatments and procedures safer for both cat and handler. While immobilization is often required, the approach should still be gentle. Figure 1.2 shows common methods of control.

Figure 1.2 Restraint for common procedures in cats. (a) Most cats will tolerate gentle extension of the neck to expose the jugular veins for blood sampling. In this image the jugular vein is occluded with the cat in lateral recumbency. (b) Restraint of the forelimb for cephalic blood sampling or IV catheterization. The handler is preventing the cat from backward movement by applying gentle pressure over the cat's hind limbs. Using the same arm, the handler is extending the right limb forward with three fingers behind the elbow to prevent retraction of the limb, and rotating and raising the cephalic vein with their first and second digits. (c) Restraint of the hind limb for medial saphenous blood sampling or IV catheterization. The cat is restrained in lateral recumbency with the dependent limb intended for venous sampling. The handler uses one hand to restrain the contralateral (upper) hind limb and apply medio-lateral pressure over the vein proximal to the sampling site. Once the vessel is visualized, the clinician directs the needle in a distal to proximal direction while maintaining control of the lower limb with the opposite hand. (d) This cat is allowed to stand freely on the treatment table and is only restrained by gentle control of the head and neck. This allows free access to the epaxial muscles for intramuscular injection.

Scruffing

Scruffing is a controversial method of restraint. Many clinics have a "no-scruffing" policy. Scruffing should be regarded as a last resort for physical restraint to avoid injuries and accidents. For these exceptional cases, the cat is gently grasped by the skin over the dorsum of the neck and scapulae, and minimal (firm) pressure is maintained. The method should certainly not be used if there is already pain or discomfort present. It is important to highlight that scruffing may lead to fear-based aggression and further escalation of stress. The American Association of Feline Practitioners (AAFP) and the International Society of Feline Medicine (ISFM) state that the technique should be used sparingly. A cat should never have its full weight suspended from the scruff.

The Fearful Cat

Fear is the most common cause of aggression in hospitalized cats. De-escalation techniques do not always work in fearful individuals. These cats exhibit strong avoidance or aggressive behavior making handling difficult. In this situation, chemical restraint should be considered before any manipulation (Chapter 3). To assist in the physical restraint of these patients, use of appropriate handling equipment is recommended (description of techniques to follow). In these cases, the equipment for IV catheter placement, and for anesthetic induction, maintenance, and monitoring should be ready.

Box 1.3: The Handling Equipment

Handling equipment should be:

• Safe for the cat and handler
• In good working order with frequent "check ups"
• Easy to use and to clean
• Suitable for the intended task

Some techniques used for appropriate restraint of the fearful and/or aggressive cat are listed below:

• Towels or blankets are commonly used for restraining fearful cats. They are often successful in protecting the handler from injury. By covering the patient, they give the cat a place to hide, minimizing visual and auditory stimulation. The handler maintains good dexterity and can assist with the procedure
• Synthetic feline facial pheromones mimic natural pheromones that are secreted by cats via facial rubbing when they are comfortable and when they mark their territories. These products have been shown to decrease stress and facilitate handling of some cats
• Masks or hoods may assist with physical restraint of some cats by limiting visual stimulation. A well-fitted mask will also protect the handler from bites. They are variably tolerated and require judicious use
• Bags for restraint protect individuals from aggressive cats. Openings in these bags allow access to the limbs and head
• Feral cats may require the use of squeeze cages, humane traps or nets for drug administration. Their application is limited to capture and restraint of cats for injection. Nets are used in exceptional conditions such as when a cat escapes or where there are extremely limited facilities. Such equipment can easily cause trauma if not used properly
• Anesthetic induction chambers may be used to anesthetize cats. This requires minimal restraint but placing the cat inside the chamber can be a challenge. While the absence of restraint is arguably better for the cat, there is potential for environmental contamination and exposure of personnel with volatile anesthetics. A fearful cat can be briefly restrained using a towel or cat bag for mask induction using volatile anesthetic agents. Techniques for induction of general anesthesia...