Sedation plus Treats for Counterconditioning

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Many advantages and negligible risk to feeding treats in the veterinary clinic.

Veterinarians and vet technicians are often impressed when they see the effects of successful counterconditioning on fearful animals: growling dogs stop snapping, and scared animals become more manageable. But as a consultant, the skeptical comment I keep hearing is: “… unfortunately we can’t feed treats because if we need to sedate animals at any time during the examination, feeding might increase the risk of Aspiration Pneumonia…”
This is a valid concern, of course. Aspiration Pneumonia (AP) is a very serious disease. But how does the risk of AP change by feeding small amounts of treats on top of what the animal already has in his stomach? And, importantly, what is the risk of not feeding? What are the potential benefits?

I conducted a literature search to investigate these questions. It turns out that there is no evidence supporting the claim that feeding small amounts of treats in the veterinary clinic would increase the risk of AP. In fact, the opposite could be argued: that AP might to some extent be avoided by feeding treats in the clinic. Indeed, I could find many benefits with treat feeding, and mostly disadvantages with not feeding treats.
AP is often, but not always, a side effect of sedation and anesthesia. Certain surgical procedures, illnesses, anesthetic drugs and regurgitation are associated with a higher risk of post-anesthetic AP.  Up to half the number of dogs vomit or have Gastroesophageal Reflux or GER during anesthesia – GER is often silent and therefore unnoticed. Unfortunately, in up to one in about 400 anesthetized or sedated dogs, this GER in turn leads to AP.

Counterconditioning. Zelda is learning that ear exams are not so bad, since they are followed by wonderful treats. Image courtesy of Eva Bodfäldt

The only known risk factor that could hypothetically be affected by feeding treats before anesthesia is regurgitation. Does feeding treats lead to an increased risk of vomiting or regurgitation at sedation? No. In dogs, extended preoperative fasting, including no access to water, actually leads to a higher incidence of GER, and there is no straightforward correlation between fasting time and GER. A few moist treats before sedation should thus not increase the likelihood of regurgitation. However, the choice of sedative most certainly will. There are drugs that cause vomiting, and drugs that don’t. Make sure to avoid the emetic compounds as far as possible when sedating / anesthetizing an animal.
If the animal regurgitates, the volume of the aspired fluids during GER is typically proportional to the gastric volume, and there are higher risks associated with larger volumes of aspired fluids. So how does treat feeding affect gastric volume? Paradoxically, feeding treats might actually lead to a reduction in gastric volume during the veterinary visit. Stress inhibits gut motility, so it is likely that in a stressed animal, gut volume may remain unaltered during the veterinary consultation – a scenario that is far more likely if you’re not treat feeding. If, on the other hand, the animal is licking a delicious treat, stress could be reduced and stomach function may be retained. Homogenized or liquid content passes very quickly through the gut. So, given a little time, there might actually be a net negative gastric volume even after adding small amounts of treats in the veterinary clinic.

Choosing not to feed animals in the vet clinic is not a neutral decision. Animals often learn to associate the location, people and procedures with painful and scary things happening. They frequently become progressively more fearful with each visit, and the majority of cats and dogs show fear when on the examination table. When fear escalates, welfare is potentially challenged, risks to animals and staff increase, and many animal owners dread and avoid taking their pet to the vet. Diagnosis becomes difficult, and some animals need to be sedated for a proper examination – and as we have seen, there is always a risk of AP during sedation.

Feeding treats is about changing associations, affecting emotional states, behavior and physiology. Rather than becoming more fearful on every subsequent visit, animals become progressively easier to handle. It is also a good opportunity to educate the owner about the usefulness of systematic desensitization and counterconditioning (SD/CC) in other areas where the animal may be fearful.
To summarize, I would encourage treat feeding in the veterinary practice since the benefits to the animal, staff and owner outweigh the potential risks. Choosing not to use counterconditioning is an active choice with multiple negative implications to both the animals and staff, including a potentially increased number of AP cases. Treat feeding will not solve all problems in the veterinary clinic, but is one powerful tool in the toolbox of prevention, planning and low-stress handling techniques available. In my opinion, treat feeding should be the norm rather than the exception in the vet clinic.

Hypothetical effects of using treats (systematic desensitization/counterconditioning: SD/CC) versus not doing so in the veterinary practice. *In order to quickly reduce gastric volume, treats are homogenized and dissolved and fed in small amounts.

Karolina Westlund is a researcher, consultant and lecturer on the topics of animal behaviour and welfare. Contact her at Illis Animal Behaviour Consulting.

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One response to “Sedation plus Treats for Counterconditioning

  1. In most cases, the medical professional is right. I know that after reading this article, you might feel the need to oppose what is procedure at the next veterinary visit. What should be done rather is ask your vet about it, there might also be other reasons they do so if the do not condone feeding snacks at the clinic.

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