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Background Butorphanol-azaperone-medetomidine (BAM™) has not been evaluated in horses. Objectives The objective of this study was to evaluate BAM™ for chemical restraint of feral horses. Study design Retrospective and prospective descriptive studies. Methods Data were collected retrospectively from medical records of 28 feral horses immobilised with BAM™ over a 6-year period. Prospectively, 0.0125 mL/kg bwt of BAM™ (butorphanol 27.3 mg/mL, azaperone 9.1 mg/mL and medetomidine 10.9 mg/mL) intramuscularly (im) was administered to eight stallions via dart, and once recumbent, 1.0 mg/kg bwt ketamine was given intravenously (iv). Induction and recovery time and quality via a standardised rubric (1 = very poor; 5 = excellent) and visual analogue scale (VAS), need for additional darts, weight tape measurement and serial physiological parameters were recorded. Serial arterial blood gas analysis was performed during recumbency. Following castration, horses were given 0.1 mg/kg bwt atipamezole (25% iv and 75% im) and allowed to recover unaided. Results Retrospectively, 28 horses were successfully immobilised with BAM™ without a major complication. Prospectively, eight horses were given a median (range) actual BAMTM dose of 0.0143 (0.0127-0.0510) mL/kg bwt. Three of eight horses needed 1, 2 or 5 additional darts. Median (range) time to recumbency was 11 (2-44) minutes. Median (range) induction (n = 4) and recovery (n = 6) scores via rubric and VAS were 5 (4-5) and 5 (5-5) and 92 (86-93) and 98 (92-99) cm, respectively. Four of seven horses were hypoxaemic at ≥1 time point with otherwise acceptable physiological parameters. Following atipamezole, median (range) time to sternal recumbency and standing was 12 (2-18) and 17 (11-52) minutes, respectively (n = 6). Main limitations The sample size was small. Data could not be collected before darting or after recovery. Some data were missing from retrospective analysis. Conclusions Intramuscular BAM™ with iv ketamine provided chemical restraint suitable for field castration of feral horses with no mortality. Hypoxaemia occurred in the majority of horses.

Background Chemical restraint (CR) is emergency drug management for acute behavioural disturbances in people with mental illness, provided with the aim of rapid calming and de-escalating potentially dangerous situations. Aims To describe a systematic review of Randomised Controlled Trials (RCTs) reporting on short-term safety and effectiveness of drugs used for CR, administered to non-consenting adults with mental health conditions, who require emergency management of acute behavioural disturbances. A meta-analysis was conducted of those RCTs with comparable interventions, outcome measures and measurement timeframes. Method Academic databases were searched for RCTs published between 1 January 1996 and 20th April 2020. Relevant RCTs were critically appraised using the 13-item JBI checklist. All RCTs were described, and step-wise filters were applied to identify studies suitable for meta-analysis. For these, forest and funnel plots were constructed, and Q and I2 statistics guided interpretation of pooled findings, tested using MedCalc Version 19.1. Results Of 23 relevant RCTs, 18 (78.2% total) had excellent methodological quality scores (at least 90%). Eight RCTs were potentially relevant for meta-analysis (six of excellent quality), reporting 20 drug arms in total. Adverse events for 6–36% patients were reported in all 20 drug arms. Four drug arms from two homogenous studies of N = 697 people were meta-analysed. These RCTs tested two antipsychotic drugs (droperidol, olanzapine) delivered intravenously in either 5 mgs or 10 mg doses, with outcomes of time to calm, percentage calm within five or 10 min, and adverse events. There were no significant differences between drug arms for either measure of calm. However, 5 mg olanzapine incurred significantly lower risk of adverse events than 10 mg olanzapine (OR 0.4 (95%CI 0.2−0.8)), although no dose differences were found for droperidol. Conclusion 5 mg intravenous olanzapine is recommended for quick, safe emergency management of people with acute behavioural disturbances associated with mental illness.

Dementia symptoms can manifest in a variety of ways, such as anxiety, agitation and an inability to communicate unmet needs. In emergency departments (EDs), these symptoms, as well as various environmental factors, can lead to behaviour that challenges in people with dementia. Therefore, ED staff must be skilled in screening, assessing and managing this patient group effectively. This article details a literature review that was conducted to explore the evidence on managing behaviour that challenges in people with dementia in the ED and what de-escalation strategies may be useful. A literature search of eight databases was undertaken, resulting in 11 articles that were included in this literature review. Four main themes were identified: violence and aggression towards staff; manual and chemical restraint in the ED; identifying delirium and dementia; and environment and person-centred care. Strategies identified to de-escalate and reduce the risk of behaviour that challenges include: making environmental modifications to the ED; providing person-centred care; excluding or evaluating pain and unmet needs; using various tools and strategies to improve communication; and using distraction techniques.

ESP | 中文 This case questions the comparative moral permissibility of 2 different uses of force—actions done against a patient’s will—in the course of that patient’s care: covert medication administration and use of physical or chemical restraint. The commentary considers what constitutes the most compassionate use of force for this patient and how it should be implemented.

Chemical restraint in dairy calves is necessary to enable diagnostic and surgical procedures. It is unclear whether xylazine or detomidine differ with regard to desirable and unwanted effects.In a prospective randomized interventional study, 10 healthy Holstein-Friesian calves (age range 3-6 month) were sedated with either xylazine (0.1 mg/kg, Group X, n = 5) or detomidine (0.03 mg/kg, Group D, n = 5) intravenously, followed by butorphanol (0.1 mg/kg i. v.) in all animals. Characteristics of sedation and selected pharmacodynamic parameters were compared between groups using a non-parametric Mann-Whitney U test.All calves (5/5) in Group X and (3/5) calves in Group D became laterally recumbent within 5 minutes. Two calves (40 %) in Group D remained standing and could not been positioned in lateral recumbency 15 minutes after initial administration of the sedation agents. Sedation scores, onset and duration of sedation did not differ between groups. Heart and respiratory rate decreased in both groups. Mean arterial pressure was with around 30 mmHg significantly higher in Group D (tand clinical relevance The xylazine-butorphanol combination provided reliable recumbent chemical restraint. With detomidine-butorphanol recumbency failed in some individuals, but a sufficient clinical sedation was achieved. Based on the limited monitoring used in this study, the side effects are of minor clinical relevance in healthy individuals.Diagnostische und chirurgische Eingriffe erfordern eine medikamentöse Ruhigstellung von Milchkälbern. Unklar ist, inwiefern sich Xylazin und Detomidin in Bezug auf ihre erwünschten und unerwünschten Wirkungen unterscheiden.Im Rahmen dieser prospektiven, randomisierten, interventionellen Studie wurden 10 gesunde Holstein-Kälber (Altersbereich 3–6 Monate) untersucht. Die intravenöse Sedation der Tiere erfolgte mit Xylazin (0,1 mg/kg, Gruppe X, n = 5) oder Detomidin (0,03 mg/kg, Gruppe D, n = 5). Anschließend erhielten alle Tiere Butorphanol (0,1 mg/kg i. v.). Neben Sedationscharakteristika wurden ausgewählte pharmakodynamische Parameter zwischen den Gruppen mit einem nicht parametrischen Mann-Whitney U Test verglichen.Alle Kälber (5/5) der Gruppe X und (3/5) Kälbern der Gruppe D legten sich innerhalb von 5 Minuten nieder. Zwei Kälber (40 %) der Gruppe D blieben stehen und konnten auch 15 Minuten nach Verabreichung der initialen Sedierung nicht in Seitenlage verbracht werden. Hinsichtlich Sedationscore, Beginn und Dauer der Sedation konnten keine Unterschiede zwischen den Gruppen festgestellt werden. Herz- und Atemfrequenz waren in beiden Gruppen während der Sedation vermindert. Der mittlere arterielle Blutdruck lag in Gruppe D um etwa 30 mmHg und damit signifikant höher (Zeitpunkt tRelevanz Die Kombination von Xylazin und Butorphanol bewirkte eine verlässliche medikamentöse Ruhigstellung und ein Niederlegen der Tiere. Mit Detomidin-Butorphanol hingegen ließ sich bei einigen Kälbern trotz ausreichender klinischer Sedationstiefe kein Niederlegen erzielen. Nebenwirkungen dieser Medikamente, die im Rahmen dieser Studie mit eingeschränktem Monitoring beobachtet werden konnten, haben bei gesunden Individuen geringe klinische Relevanz.

Ten free-living adult coatis (two males and eight females) were chemically restrained with "ZAD-50", a concentrated formulation prepared with the dehydrated content of a Zoletil/50® vial diluted with 0.25mL of 1% atropine, 0.265mL of Dormiun-V®, and 2.2mL of distilled water, being exactly 3.0mL. The formula was administered to each animal previously captured and physically contained with a net. The loss of righting reflex (RR) occurred at 2.3±0.8 minutes post-injection (MPI), with anesthesia beginning at 4.4±2.7 MPI. Myorelaxant and analgesia were considered excellent at all moments of the evaluation. Conscious reactions were observed at 78.7±22.2 MPI, the return of the RR occurred at 101 ± 18 MPI, and normal ambulation was acquired at 137.0±31.0 MPI. The mean values of physiological parameters measured every 10 minutes between 10 and 50 MPI were 152.2 heartbeats per minute for heart rate, 66.4 respiratory movements per minute for respiratory rate, 39.2oC for rectal temperature, 86.2% for SpO2 and 14.6 mmHg for systolic blood pressure. In the same times, the EEG registered sinus rhythm. No adverse reactions were observed, and the assessed vital parameters remained compatible with the state of chemical restraint.

Complaints reflect a person’s or family’s experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020. A total of 1134 complaint issues specifically referenced medication use. Using content analysis, with a dedicated coding framework, we found that 45% of these complaints related to medicine administration processes. Three categories received nearly two thirds of all complaints: (1) not receiving medication at the right time; (2) inadequate medication management systems; and (3) chemical restraint. Half of the complaints described an indication for use. These were, in order of frequency: ‘pain management’, ‘sedation’, and ‘infectious disease/infection control’. Only 13% of medication-related complaints referred to a specific pharmacological agent. Opioids were the most common medication class referred to in the complaint dataset, followed by psychotropics and insulin. When compared to complaint data composition overall, a higher proportion of anonymous complaints were made about medication use. Residents were significantly less likely to lodge complaints about medication management, probably due to limited engagement in this part of clinical care provision.

In the context of psychiatric emergencies, it is important to distinguish between so-called controllable agitation and uncontrollable agitation. In this context, physical restraint of the adult patient is sometimes necessary, but remain an exceptional measure. Restraints must be applied rapidly and in a protocolised manner. It should be used sparingly in the elderly patient. Physical restraint is a medical prescription that must be accompanied by chemical restraint.

Au Québec, les mesures de contrôle – isolement, contentions et substances chimiques – font l’objet d’un encadrement législatif depuis 1998. Or, depuis cette date, les substances chimiques sont au coeur d’un débat sur leur statut juridique, entre thérapie et contrôle. En 2015, le ministère de la Santé et des Services Sociaux publie un Cadre de référence révisé sensé établir des normes directrices en matière de substances chimiques utilisées à des fins de contrôle. Un examen de ce cadre laisse pourtant transparaître plusieurs incohérences, entretenant l’indétermination sur leur statut. D’une part, l’exception prévue en matière de consentement ne correspond pas au cadre juridique québécois en matière de soins, laissant penser qu’il s’agit bien d’une mesure de contrôle. D’autre part, les actes réservés sont les mêmes, que les substances chimiques soient utilisées à des fins de contrôle ou à des fins thérapeutiques, laissant penser qu’il s’agit plutôt d’une mesure thérapeutique., In Quebec, control measures – isolation, restraints and chemical substances – have been the subject of a legislative framework since 1998. However, since that date, chemical substances have been at the heart of a debate on their legal status, between therapy and control. In 2015, the Ministry of Health and Social Services published a revised Reference Framework that is supposed to establish guidelines for chemical substances used for control purposes. A review of this framework, however, reveals several inconsistencies, continuing an indeterminacy about their status. On the one hand, the consent exception does not correspond to the Quebec legal framework for care, suggesting that it is indeed a control measure. On the other hand, the reserved acts are the same whether the chemical substances are used for control or for therapeutic purposes, suggesting that it is in fact a therapeutic measure.

Behavioural assessment units (BAU) have been established in emergency departments (EDs) to provide short-term observation, treatment, and care to people experiencing acute behavioural disturbance. A prospective observational study was conducted in a cohort of adult patients admitted to one BAU located within an ED (July-December 2017) to compare clinical characteristics, treatment outcomes, and use of restrictive interventions for those who received a specialist mental health (MH) assessment with those who did not. Of the 457 patients, 61.5% received a specialist MH assessment. This group had a lower acuity (Australasian Triage Score 10.4%; CI 0.2-2.0% vs 13.6%; CI 9.3-19.5%); more arrived with police (28.8%; CI 23.8-34.3 vs 5.1%; CI 2.7-9.4%); and were subjected to restrictive interventions while in the BAU. Security responses for unarmed threat (code grey) were higher (10.9%; CI 7.8-15.0% vs 4.4%; CI 2.3-8.5%), as was the use of chemical restraint (4.2%; CI 2.4-7.2 vs 0.0% CI 0.0 - 2.1%). Those requiring specialist MH assessment had a longer length of stay (12.7 vs 5.2 hours). Further development of the BAU model of care must include targeted, evidence-based strategies to minimize the use of restrictive interventions and ensure timely access to acute mental health services.

OBJECTIVE To explore the use of a modified pupillometry technique in dogs without chemical restraint. MATERIALS AND METHODS Following dark adaptation, pupillary light reflexes were assessed in six dogs with sudden acquired retinal degeneration syndrome, in the unaffected eye of eight dogs with unilateral primary glaucoma ("predisposed"), and in 11 healthy dogs. Responses to red, blue and white lights were recorded and relative pupil sizes subsequently determined based on video recordings of each test. RESULTS Mean testing time was 2.3 minutes (range 1.8 to 3.1 minutes), excluding time for dark adaptation. Baseline pupil size in dogs with sudden acquired retinal degeneration syndrome was greater than in normal and predisposed eyes. Pupil constriction was reduced in predisposed compared to normal and sudden acquired retinal degeneration syndrome eyes when stimulated with high-intensity blue light. Compared to normal eyes, those with sudden acquired retinal degeneration syndrome had reduced pupil constriction when stimulated with low- and high-intensity red light, low-intensity blue light and white light. CLINICAL SIGNIFICANCE Quantitative measures of pupil function were obtained from healthy and diseased eyes without the need for chemical restraint. Further investigations are warranted to validate the technique and evaluate its use in the management of canine glaucoma.

The prevalence of security guards in health care settings is growing worldwide. There is a need to explore and understand their role and actions to inform policy and training and support least restrictive practices in health care. The aim of this study was to conduct a retrospective chart audit of security guard logs to investigate security guard involvement in Code Blacks, called in emergency situations of personal threats including patient and/or visitor violence, in medical and surgical wards in a large metropolitan health network in South Australia. Security guards attended 1664 Code Blacks (0.63% of admissions) over the 2.5-year study period. Events were more frequently reported in medical than surgical wards. The most common reasons for security guard attendance were patients threatening/harming staff and patients threatening/harming themselves. The most frequent security guard actions were "Attend only/standby," "Physical restraint," and "Patient located and returned to the ward." The most frequent outcomes were physical restraint, chemical restraint, and de-escalation respectively. Results highlight the imperative that health services maintain and increase efforts to support least restrictive practice through policy directives and staff training.

Violent, combative and intoxicated patients are a common problem in the emergency department, and the emergency physician must be prepared to control the situation safely and effectively when a patient begins to exhibit dangerous behavior. This article reviews initial de-escalation techniques to reduce the need for patient restraint. It then details the 2 types of restraints (physical and chemical) and the clear indications for each type. The high-risk nature of utilization of restraints is reviewed, as well as the means by which to ensure patient and staff safety and decrease adverse outcomes.

OBJECTIVE: Mental health (MH) presentations to ED are increasing in children and adolescents. Little is known about patients with severe acute behavioural disturbance (ABD). We set out to describe patients with ABD severe enough to trigger an acute crisis team response in ED (termed 'Code Grey') and how they differ from other MH patients. METHODS: Retrospective electronic medical record review of all ED patients with MH discharge codes at a tertiary children's hospital. We assessed the epidemiology and management of patients who triggered acute crisis team interventions (Code Grey) as proxy for severe ABD. We calculated the odds ratios (ORs with 95% confidence intervals) of key demographic factors compared to other MH patients. RESULTS: During 2018, there were 85 347 ED presentations of which 1695 (2.0%) were related to MH diagnoses; 84 MH patients had 141 MH presentations triggering 204 Code Greys (26 patients triggered 59% of Code Greys). These patients had higher triage acuity (OR 12.6 [8.3-19.0]), stayed longer in ED (>12 h OR 8.2 [5.1-13.1]) and were more likely to be admitted (OR 2.0 [1.4-3.0]) compared with non-Code Grey MH presentations. Patients were physically (19.2%), mechanically (31.9%) or chemically restrained (37.6%). Eight different medication approaches were used as either a single agent or a combination of oral and/or intramuscular agents. CONCLUSIONS: Children and adolescents with severe ABD differ from other MH presentations and often require physical or chemical restraint. Anticipatory management plans may be valuable for repeat presenters.

Background This study evaluated and compared cardiorespiratory and blood gas parameters, as well as sedation, analgesia and recovery of two protocols: ketamine (10 mg/kg) or dexmedetomidine (10 μg/kg), with midazolam (0.5 mg/kg) and butorphanol (0.3 mg/kg), IM (KBM and DBM, respectively) in brown howler monkeys (Alouatta guariba clamitans). Material and methods Twelve brown howler monkeys were selected in two groups and evaluated for cardiorespiratory parameters and sedation, from 5-30 minutes after latency. Blood gas and arterial lactate were taken at 5 and 30 minutes. In the end, time and quality of recovery were evaluated. Results The HR in DBM group was significantly lower at all times. The sedation score was higher in DBM. Recovery in DBM was faster. All animals had moderate hypoxaemia. Conclusion Both protocols produce satisfactory anaesthesia and analgesia, but DBM provides deeper sedation with faster recovery. Oxygen supplementation is recommended in both due to hypoxaemia.

Background The use of chemical restraints (CRs) in health care facilities is a complex intervention that raises questions about its effectiveness and whether it is safe and patient oriented. Purpose This review aims to gather nursing quality standards for the use of CR through an innovative method of knowledge synthesis, the realist review, to support the development of a quality evaluation tool. Methods A realist review method was chosen. Results An operational definition of chemical restraint is proposed, a concept seen as synonymous with the management of behavioral symptoms by pharmacological agents with sedative proprieties. Twenty-eight quality standards were identified and presented in a theoretical model. Conclusions These quality standards will allow the evaluation of practices from a nursing perspective for the use of CR in health care settings.

WHAT IS KNOWN ON THE SUBJECT?: The use of chemical restraint in emergency situations is to control aggression or violence to protect consumers and staff and is to be used as a last resort when all other behavioural control alternatives have been exhausted. Chemical restraint involves the use of medication. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first paper to systematically review the prevalence of the use of chemical restraint. The use of chemical restraint is common across emergency departments and acute psychiatric inpatient units worldwide. Consumers who are restrained are also likely to receive chemical restraint. The studies reviewed demonstrate that there is a need for more standardized data collection so that clearer comparisons can be made between healthcare settings and countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Implications of practice include the need to report adverse events post-chemical restraint as these can deleteriously affect a person's physical health. Identification of and staff education about first-line management techniques before chemical restraint is administered are significant to reduce its use. ABSTRACT: Introduction Chemical restraint is used to manage uncontrolled aggression, agitation or violent behaviours of consumers with mental health disorders admitted to acute psychiatric or emergency settings. Aim This systematic review aimed to synthesize the international prevalence of chemical restraint for non-consenting adults. Method PsycINFO, CINAHL, MEDLINE/PubMed and Google Scholar databases were searched for peer-reviewed literature published between January 1996 and July 2018. This paper reports on data extracted from retrospective audits of chemical restraint practice. Results Forty-eight papers were included. The median prevalence of use of any restraint was 21.2% (25th% 8.0 to 75th% 36.3). Median prevalence of people who were chemically restrained, of all people restrained in any manner, was 43.1% (25th% 22.9% to 75th% 70.7%). Of all people admitted to facility(ies), the median prevalence of chemical restraint was 7.4% (25th% 2.7 to 75th% 17.6). There was no statistically significant difference in any prevalence measure considering healthcare setting or country. There was a significant decrease over the review period in the use of any restraint, including chemical restraint. Discussion and implications for practice This is the first known comprehensive meta-view of chemical restraint use worldwide, highlighting the need for standardized data collection to enable comparisons between healthcare settings and countries. Relevance statement There is an international imperative to reduce or eliminate the use of coercive practices, such as physical and chemical restraint, in mental health care. This study provides important information for mental health nursing by synthesizing the international prevalence of chemical restraint for non-consenting adults. This meta-view of the worldwide use of chemical restraint can inform ongoing efforts to reduce its use.

Objective To explore the meaning and potential role of new Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019, (Principles) which amend Quality of Care Principles 2014 in improving practice around physical and chemical restraint. Methods We examined both Principles and accompanying Explanatory Statement in light of best practices around consent and use of chemical and physical restraint. Results The chemical restraint definition is problematic by exclusion of medications for treating mental disorders, physical illness or physical conditions, which is not considered restraint. Inexplicably, physical restraint requirements are more rigorous than chemical restraint requirements, where assessment is optional, and consent sometimes obtained, after use, and from the person's “representative,” rather than the person first, followed by their proxy decision‐maker. Conclusions Although a start in promoting best practice around physical restraint, the Principles do not address the status quo of poor practice around chemical restraint and may instead codify it.

The field of lizard sedation, anesthesia, and locoregional anesthesia is advancing with new drug protocols being evaluated, and new locoregional techniques being developed and evaluated. Inducing and maintaining effective and safe chemical restraint in lizards can be challenging, particularly in systemically diseased individuals. Understanding the anatomic and physiologic adaptations of lizards, using reversible or partially reversible injectable protocols, and using locoregional anesthesia may increase the quality of chemical restraint, facilitate faster recoveries, and limit anesthesia-related morbidity and mortality.

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint, 2. Support for legislation, 3. Restraint-free environments are not possible, 4. Low-level restraint, 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.

Chemical restraint is the immobilization of an animal through the use of anesthetic drugs for a short period of time. This process should be quick, easy to control, safe, and have few side effects. Restraint of Phocids is used for research and medical purposes. Marine mammals possess alterations in their anatomy and physiology to live in a marine environment. Furthermore, there is an intricate physiological and behavioral reaction that occurs when these animals dive. All these adaptations should be known as they may cause certain complications during anesthesia. Therefore, chemical restraint should be planned according to the species, weight, behavior and location of the phocid. There are many different agents that have been applied to Phocids, but combinations with cyclohexylamines are often used in the chemical immobilization of these animals. The combination of Tiletamine-Zolazepam is one of the most used protocols in these species since it requires small amounts and allows a rapid induction with predictable responses. However, certain side effects may happen during chemical restraint, such as apnea and profound bradycardia, which are yet to be fully understood. Therefore, careful monitoring of anesthesia is vital for a successful immobilization. Further studies are needed to understand the cause of the common complications that occur during phocid immobilizations to be better prepared when these happen. Chemical restraint in marine mammals is an evolving area in which new protocols, agents and techniques are still being investigated. A contenção química é a imobilização do animal com recurso a agentes anestésicos durante um curto período de tempo. Este processo deve ser rápido, fácil de controlar, seguro e ter poucos efeitos secundários. A contenção de focídeos é utilizada para aspetos de investigação e medicina. Os mamíferos marinhos possuem alterações na sua anatomia e fisiologia para viverem num ambiente marinho. Ademais, existe uma reação fisiológica e comportamental bastante complexa que ocorre nestes animais ao mergulhar. Todas estas adaptações devem ser conhecidas, pois podem causar certas complicações durante a anestesia. A contenção química deve ser planeada de acordo com a espécie, peso, comportamento e localização do focídeo. Existem vários agentes químicos que têm sido aplicados em focídeos, mas as combinações com ciclohexilaminas são frequentemente utilizadas na imobilização química destes animais. A combinação de Tiletamina-Zolazepam é um dos protocolos mais utilizados nestas espécies devido a requer pequenas quantidades e permitir uma rápida indução com respostas previsíveis. No entanto, existem alguns efeitos secundários que surgem durante a contenção química, como a apneia e bradicardia profunda, cujas causas ainda não são inteiramente conhecidas. Assim, é importante haver uma monitorização cuidada da anestesia para a imobilização ser bem-sucedida. É relevante estudar mais detalhadamente a causa destas frequentes complicações que ocorrem durante as imobilizações químicas, a fim de saber agir melhor quando estas acontecem. A contenção química de mamíferos marinhos é uma área em evolução em que novos protocolos, fármacos e técnicas ainda estão a ser investigados.

This study aimed to evaluate the effectiveness of acepromazine as an adjuvant to ketamine, midazolam and methadone in the chemical restraint and anesthesia of cats undergoing ovariohysterectomy. We allocated 14 cats in two groups: group ketamine (GK), premedicated with ketamine 8 mg/kg, midazolam 0.3 mg/kg and methadone 0.3 mg/kg and group acepromazine (GAK), premedicated with acepromazine 0.05 mg/kg in addition to the above-mentioned drugs. At baseline (T0) and every 5 mins up to 20 mins (T5, T10, T15 and T20) after premedication, the sedation score was evaluated at 0 to 24 points. The sedation score was significantly higher at T5, T10, T15 and T20 in both groups. There were no significant differences in extubation times (3.7 ± 1.3 mins in GK; 5.2 ± 2.6 mins in GAK) and the time to reach a score equal to 0 on the sedation scale (88 ± 63.9 mins in GK; 133 ± 39.7 mins in GAK); however, the time of anesthetic release was significantly higher in the GAK than in GK (19.7 ± 6.5 mins vs 11 ± 5.9 mins) (P = 0.023). Sedation was adequate in both groups. The results indicated that the administration of acepromazine did not contribute to sedation in the protocol and could delay the anesthetic release. El objetivo de este estudio fue evaluar el efecto de la acepromazina con adyuvante al protocolo de ketamina, midazolam y metadona sobre la contención química y la anestesia de gatos sometidos a ovariosalpingohisterectomía. Los animales fueron divididos en dos grupos: grupo ketamina (GK), premedicado con ketamina 8 mg/kg, midazolam 0,3 mg/kg y metadona 0,3 mg/kg, y el grupo acepromazina (GAK), premedicado con acepromazina 0,05 mg/kg asociado a los fármacos mencionados anteriormente. Al inicio (T0) y cada 5 minutos hasta 20 minutos (T5, T10, T15 y T20), después de la premedicación, se evaluó un puntaje de sedación de 0 a 24 puntos. La sedación fue significativamente mayor en T5, T10, T15 y T20 en ambos grupos. No hubo diferencias significativas en los tiempos de extubación (3,7 ± 1,3 minutos en GK; 5,2 ± 2,6 minutos en GAK); y a tiempo para lograr una puntuación igual a 0 en la escala de sedación (88 ± 63,9 minutos en GK; 133 ± 39,7 minutos en GAK); sin embargo, el tiempo de descarga anestésico era perceptiblemente más largo en GAK que en GK (19,7 ± 6,5 minutos contra 11 ± 5,9 minutos) (P = 0,023). La sedación fue adecuada en ambos grupos. La administración de acepromazina no contribuyó a la sedación y aumentó el tiempo de anestésico alto. O objetivo desse estudo foi avaliar o efeito da acepromazina com adjuvante ao protocolo de cetamina, midazolam e metadona na contenção química e anestesia de gatas submetidas a ovariosalpingohisterectomia. Os animais foram divididos em dois grupos: grupo cetamina (GK), premedicados com cetamina 8 mg/kg, midazolam 0,3 mg/kg e metadona 0,3 mg/kg, e o grupo acepromazina (GAK), premedicados com acepromazina 0,05 mg/kg associada aos fármacos citados anteriormente. No momento basal (T0) e a cada 5 minutos até 20 minutos (T5, T10, T15 e T20), após a premedicação, um escore de sedação foi avaliado de 0 a 24 pontos. A sedação foi significativamente maior nos T5, T10, T15 e T20 em ambos os grupos. Não teve diferença significativa nos tempos de extubação (3.7 ± 1.3 minutos no GK; 5.2 ± 2.6 minutos no GAK); e no tempo para alcançar escore igual a 0 na escala de sedação (88 ± 63.9 minutos no GK; 133 ± 39.7 minuto no GAK); entretanto, o tempo de alta anestésica foi significativamente maior no GAK do que no GK (19.7 ± 6.5 minutos contra 11 ± 5.9 minutos) (P = 0.023). A sedação foi adequada em ambos os grupos. A administração de acepromazina não contribuiu para a sedação e aumentou a o tempo de alta anestésica.

Capybara (Hydrochoerus hydrochaeris) is the main host of tick-borne pathogens causing Brazilian spotted fever; therefore, controlling its population is essential, and this may require chemical restraint. We assessed the impact of chemical restraint protocols on the partial pressure of arterial oxygen (PaO2) and other blood variables in 36 capybaras and the effect of different flows of nasal oxygen (O2) supplementation. The capybaras were hand-injected with dexmedetomidine (5 μg/kg) and midazolam (0.1 mg/kg) and butorphanol (0.2 mg/kg) (DMB, n = 18) or methadone (0.1 mg/kg) (DMM, n = 18). One-third of the animals were maintained in ambient air throughout the procedure, and one-third were administered intranasal 2 L/min O2 after 30 min whereas the other third were administered 5 L/min O2. Arterial blood gases, acid-base status, and electrolytes were assessed 30 and 60 min after drug injection. The DMB and DMM groups did not vary based on any of the evaluated variables. All animals developed hypoxaemia (PaO2 44 [30; 73] mmHg, SaO2 81 [62; 93] %) 30 min before O2 supplementation. Intranasal O2 at 2 L/min improved PaO2 (63 [49; 97] mmHg and SaO2 [92 [85; 98] %), but 9 of 12 capybaras remained hypoxaemic. A higher O2 flow of 5 L/min was efficient in treating hypoxaemia (PaO2 188 [146; 414] mmHg, SaO2 100 [99; 100] %) in all the 12 animals that received it. Both drug protocols induced hypoxaemia, which could be treated with intranasal oxygen supplementation.

One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast-acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre-hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm; time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base.

Maximizing animal wellbeing by minimizing drug-related side effects is a key consideration when choosing pharmaceutical agents for chemical restraint in nonhuman primates. One drug combination that may promote this ideology is butorphanol (27.3 mg/mL), azaperone (9.1 mg/mL), and medetomidine (10.9 mg/mL; BAM). Based on results from a pilot study, 2 doses of BAM (16 and 24 μL/kg IM) were compared in healthy, 3-y-old rhesus macaques. Physiologic parameters and anesthetic quality were assessed and recorded every 5 min. Experimental endpoints were established for hypoxemia (85% or less peripheral oxygen saturation with oxygen supplementation), pulse rate (80 bpm or less for 2 consecutive readings), mean arterial pressure (MAP; 50 mm Hg or less), and hypothermia (97 °F or less); if any endpoint was achieved, medetomidine was reversed by using atipamezole (0.22 mg/kg IM). Both BAM doses resulted in immobilization of all animals with no clinically significant differences between groups. All animals initially exhibited hypoxemia that resolved with oxygen supplementation. Regardless of dose, most macaques (71%) reached established experimental endpoints for bradycardia (62 to 80 bpm) or hypotension (44 to 50 mm Hg MAP). Given the results of this study, our recommendation regarding the use of 16- or 24-μL/kg BAM for immobilizing rhesus macaques is dependent on caution regarding cardiopulmonary parameters and the provision of supplemental oxygen.

Reducing and/or eliminating the use of coercive measures in psychiatric services is a priority worldwide. Chemical restraint is one such measure, yet to date has been poorly defined and poorly investigated. The aim of this study was to examine chemical restraint use in 12 adult acute inpatient psychiatric units in Adelaide, South Australia. Methods involved the analysis of all reported chemical restraint events occurring over a 12-month period analysed using a descriptive quantitative design. There were 166 chemical restraint events involving 110 consumers. The highest prevalence rate in an individual unit was 28.78 events per 1000 occupied bed days, with the lowest being 0.12 events per 1000 occupied bed days. More males (n = 69, 57.5%) were involved in chemical restraint than females. Schizophrenia, schizotypal, and delusional disorders were the predominant diagnoses among consumers who were chemically restrained. The most events occurred during three time blocks: 14.00-14.59 pm, 16.00-16.59 pm, and 21.00-21.59 pm. The two most common medications used were olanzapine and clonazepam. The study presents a general picture of the practice of chemical restraint in Adelaide and identifies areas of concern in relation to the need for monitoring of side effects and completion of systematic processes of documentation regarding chemical restraint events. Findings highlight the need for sustained focus on reducing the need for chemical restraint and exploring less restrictive measures with those most likely to receive medication against their will.