Mindful Veterinary Training and Education

05/23/2026

If I could marry one piece of hospital equipment, it would be the capnograph. It would be a small wedding - close friends and family only. Allow me to read you my vows:
1. You know her, you love her, she’s your normal capnograph. Confirms ventilation, perfusion, and circuit integrity in one glance. If the shape changes, something in your patient or equipment changed.
2. Rebreathing. Baseline is NOT dropping to 0. Multiple causes under GA. Change the absorbent, check valves, increase fresh gas flow, reassess circuit choice depending on cause
3. Shark fin, aka an obstruction or bronchospasm. Common in asthmatic patients; other causes include ETT related issues. Check the tube first (Measure distance, consider sterile suction, reposition), or consider bronchospasm/lower airway disease and consider bronchodilators like terbutaline.
4. ETT cuff leak. We know we need to immediately check for a cuff seal once we intubate, but what we sometimes forget is to check again once the patient is at a deeper plane and the cervical muscles relax! Check cuff inflation using a digital pressure reader: White, et. al showed this was the most effective method of 4 different ways to check cuff pressure.
5. Sudden drop to zero - This requires understanding the concept of ventilation/perfusion mismatch and is very thoroughly discussed in my CPR for general practice training in a simplified way. EtC02 is not just a representation of respiratory status but also perfusion status. We need perfusion to generate EtC02, so when a patient is in cardiac arrest and perfusion stops, EtC02 won’t be produced. This is why the capnograph is SO important to have on patients, especially during CPR. It’s the only non-invasive machine to tell you when your patient has arrested AND when they have ROSC!
Need help introducing (or reintroducing) a capnograph into your practice? I’d love to help you with that - including formal, interactive lecture, helping to choose proper equipment, training your trainers based on adult learning principles, and nervous system regulation for those who get a little stressed from anesthesia. Book your discovery session today on mindfulvet.co

05/19/2026

📢 Hey vet med! Before you place a Fentanyl patch on your patient, take a look at what the evidence says in terms of recommended sites, absorption, and limitations of use.

🐕 Placement sites: Stick to the lateral/dorsal thorax or dorsal cervical region. Limbs and tails do not provide the best guaranteed absorption.
Placement technique: Clip GENTLY with clean electric clippers, wipe off loose debris with water/dry gauze ONLY, and press firmly and hold the patch down for 60 seconds.
🕑 Time to analgesia: Based on published studies, dogs: 24 hours to reach effective plasma concentrations. Cats: 7–14 hours. Time your injectable/oral analgesics accordingly.
🌡️ Temperature: Fever increases fentanyl absorption, hypothermia reduces it. Ensure (as best you can) your patient won’t suffer from either after patch placement and avoid placing before surgery/anesthesia.
📊 Probability of absorption: In research 36% of the Fentanyl dose was absorbed in cats and a mean of 17% in dogs! If you’re placing a patch, understand these limitations: Pain score, do not rely on for sole analgesia, have a back up plan as needed.
🗑️ Disposal: A significant amount of Fentanyl can remain in the patch after removal creating a safety risk for at-home disposal. Wear gloves to remove, fold adhesive side in, have client return to clinic or review your state’s DEA protocol.
The 2022 AAHA Pain Management Guidelines formally discourage fentanyl patch use in dogs — citing highly variable pharmacokinetics and human exposure risk. The 2022 WSAVA Pain Guidelines state that in cats, patches “are highly variable and may fail to produce analgesia.” There is no expert consensus on their utility in cats. If you’re going to use them, understand placement technique and their limitations - do not use as a standalone but rather alongside multimodal analgesia.
👇🏼References in comments!

05/12/2026

While there are numerous analgesic medication options for canines and felines to help treat acute/surgical pain, back orders on the rise, contraindications to NSAIDs, and cost can present frustrating roadblocks. What if your best analgesic wasn’t found in a bottle, but rather in the looking at managing the entire perioperative experience?

1️⃣The link between fear and pain: Fear and pain both activate the HPA axis and the sympathetic nervous system, flooding the body with cortisol and catecholamines. Managing fear is your best pharmacology!
2️⃣ Get fear free certified: Fear Free certification was founded by Dr. Marty Becker and builds on Dr. Sophia Yin’s Low Stress Handling framework — now the standard of care endorsed by AAFP, ISFM, and AAHA. Low-stress handling, touch gradient, passive treat offering and more have been clinically proven to improve fear and therefore, better manage pain.
3️⃣Environmental considerations: Carrier training, pheromone therapy, and specific music for cats have all been proven to reduce stress and cortisol. Controlling your waiting room and recovery environments have shown particular evidence for lower cortisol levels in dogs and cats, and can make a big difference in your patient’s experience of pain. These practices are consistent with the neurobiology of the sensory stress response, even where not independently trialed.
4️⃣ Halstead Principles: Surgical Technique as Analgesia: Careful tissue handling, precise dissection, minimal trauma, adequate hemostasis, and tension-free closure are as relevant to pain management today as any drug we prescribe.
5️⃣ Beyond the OR and the prescription pad, several non-pharmaceutical modalities have genuine evidence behind them for acute and surgical pain: Cryotherapy, laser therapy, PT and physiotherapy, and even acupuncture can all be considered as a part of a multi-modal analgesic approach. Think about the calming effects of gentle touch when your pain state is unregulated - gentle massage and nursing care can work wonders in controlling upregulated states.
👇🏼References in comments!

05/04/2026

The AAHA Pain Mgmt guidelines clearly state that Gabapentin use has become common for acute pain, without supporting data. So what are our options for acute pain management in FELINES, especially when to-go-home medication options feel sparse? 🤷🏻‍♀️
1️⃣Buprenorphine! OTM/sublingual route achieves bioavailability approaching 100% in cats. When available, it remains the most practical TGH option for feline patients experiencing postop/acute pain. *Do NOT admin SQ unless you’re using simbadol, and use doses > 0.02mg/kg for OTM.
2️⃣ Simbadol to the rescue: Higher concentrated Bup indicated for SID use, however A 2024 PK/PD effective analgesia at the 0.12 mg/kg dose. Consider TGH Simbadol BID at 0.12mg/kg in place of Bup if it makes a cost difference, or the latter is on backorder. OTM Simbadol BID option to owners has not been clinically studied, however evidence shows OTM Simbadol is absorbed well.
3️⃣ Zorbium: Especially good consideration for cats difficult to handle/medicate needing extended pain control or when cost/backorders are a concern. Most common side effects noted are dysphoria and hyperthermia - use caution and pain score when only using the small dose tube for all size cats as this has not been studied and could result in inappropriate analgesia.
4️⃣NSAIDs: Meloxicam and Robenacoxib have demonstrated efficacy for OHE and orthopedic pain and are excellent multimodal partners with other analgesics. Multiple contraindications exist making careful patient selection key!
5️⃣ Tramadol: Unlike in dogs, clinical studies have found tramadol provides postoperative analgesia in cats comparable to morphine after OHE. The bitter taste is a drag - compound to improve compliance!
6️⃣ Fentanyl patches: Can be a useful option in cats following major surgery or severe pain, however proper placement is essential!
🙌🏼 The more robustly you manage pain preemptively, the less dependent your feline patient is on whatever go-home options the supply chain allows. The addition of adjuncts, Ket + Lido CRIs and LB’s are our key to pain mgmt. Reach for Amantatdine, Bonqat, and SQ ketamine in more complex cases, backorders, or for neuropathic/complex pain. References 👇🏼

05/02/2026

I’m really excited to support this group of CrVT representatives 😍

Are you attending this weekend?

Register here!!
https://docs.google.com/forms/d/e/1FAIpQLScjhK3VJyRCxgibPoZbeOJOQws8RdSZMWIwKnYL85wxJ265wg/viewform

04/26/2026

The 2022 AAHA Pain Mgmt guidelines clearly state that Gabapentin use has become widespread and common for acute pain, although without supporting data. 🤷🏻‍♀️So what are our options for acute pain management in canines when to-go-home medication options feel sparse?
1️⃣ NSAIDs remain the most efficacious, but multiple contraindications exist. Grapiprant and Robenacoxib can pick up some of the slack in cases where there is concern.
2️⃣ Acetaminophen: Our next best option?
Best used as an alternative when GI, renal, or concurrent steroid concerns preclude traditional NSAIDs. While the oral route shows promising effect in studies, the injectable studies are mixed.
3️⃣ Codeine? Oral bioavailability is approximately 6.5% in dogs, with negligible conversion to morphine. It can be included with multimodal analgesia when opioid contribution is desired and stronger options are unavailable, or NSAIDs are contraindicated. Not appropriate for moderate to severe pain as a sole agent.
4️⃣ Buprenorphine OTM? Low, variable absorption, cost, and availability make it a less attractive option for canines. However, the intranasal route is worth watching since it could be a practical go-home route.
5️⃣ Fentanyl patches? Time delayed, variable, and not clearly superior analgesia in most comparative studies. The evidence is largely older and the picture has never been particularly compelling. Recuvyra is a meaningfully different product with genuine evidence base and FDA approval — but it requires appropriate timing, and careful patient selection. Application is key in both!
6️⃣ Tramadol? Studies have proven time and time again it should not be relied upon as a primary analgesic for acute pain in dogs.
🙌🏼 Our best bet to manage pain well at home? Multimodal analgesia, in the clinic, preemptive when possible.
Pure mu opioids OR Buprenorphine PLUS locals, with the addition of adjuncts, when not otherwise contraindicated and chosen based on severity of pain, are our best answers. Understand and utilize extenders to local techniques when applicable. Pain scoring always, for the win! 👇🏼References in comments.

04/14/2026

🙋🏽‍♀️ Raise your hand if you are a visual learner who struggles to focus during formal CE lectures!

😭 Me too, friends. Me too.

With a fondness for art & design, I strive for my trainings to be as visually engaging and interactive as possible. That means:

✅Clear, bold design
✅Asking the audience a question or reflection at least once every 7 minutes
✅ Always tying in evidence-based research to real life clinic scenarios
✅ Indicating which slides you’ll want to screenshot 🤳
*Save this first slide when remembering how to troubleshoot all sources of hypotension in anesthetic patients, or when training others!

☝🏼Here are a few slides from one of my most popular trainings, “Intraoperative fluid therapy: Creating an algorithm for hypotension”.

🧐What do you want to see more of in veterinary CE? What is most helpful for you in terms of creating a learning environment?

Lemme know in the comments 👇🏼

04/12/2026

I'm alllllll about novel methods for fluid responsiveness in VetMed!

I collected data alongside Dr. William Muir in 2012 for one of the first veterinary medicine studies on Pleth Variability Index (PVI) and speak about it often in my trainings on intraoperative hypotension.

What do you all think about this technique and study?
Have any of you tried it?

When a dog is hypotensive, our instinct is to give fluids. But here’s the catch:

𝗡𝗼𝘁 𝗲𝘃𝗲𝗿𝘆 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝘄𝗶𝗹𝗹 𝗯𝗲𝗻𝗲𝗳𝗶𝘁 𝗳𝗿𝗼𝗺 𝗳𝗹𝘂𝗶𝗱𝘀.

Some will improve…
Others may not—and can even develop fluid overload.

So the real question is:
Can we predict fluid responsiveness before giving fluids?

𝗥𝗲𝘀𝗲𝗮𝗿𝗰𝗵𝗲𝗿𝘀 𝗲𝘅𝗽𝗹𝗼𝗿𝗲𝗱 𝗮 𝘁𝗲𝗰𝗵𝗻𝗶𝗾𝘂𝗲 𝗰𝗮𝗹𝗹𝗲𝗱 𝗹𝗶𝘃𝗲𝗿 𝗰𝗼𝗺𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻:

➡️ Apply gentle pressure to the mid-abdomen for ~1 minute
➡️ This shifts blood from the liver back into circulation
➡️ Essentially acting like a “mini fluid bolus” without fluids

(Similar to passive leg raising, which shifts blood from the limbs—but less practical in dogs.)

𝗪𝗵𝘆 𝘁𝗵𝗶𝘀 𝘄𝗼𝗿𝗸𝘀

The liver stores a significant amount of blood.
When compressed:

Blood returns to the heart
Preload increases
Cardiac output may improve

𝗜𝗳 𝘁𝗵𝗲 𝗽𝗮𝘁𝗶𝗲𝗻𝘁 𝗶𝘀 𝗳𝗹𝘂𝗶𝗱 𝗿𝗲𝘀𝗽𝗼𝗻𝘀𝗶𝘃𝗲, 𝘆𝗼𝘂’𝗹𝗹 𝘀𝗲𝗲 𝗮 𝗺𝗲𝗮𝘀𝘂𝗿𝗮𝗯𝗹𝗲 𝗰𝗵𝗮𝗻𝗴𝗲.

In hypovolemic dogs:

Stroke volume increased by ~30%
Blood pressure increased
Preload indicators improved

In normal dogs: No significant changes

This could become a useful way to:
✔️ Avoid unnecessary fluid therapy
✔️ Reduce risk of fluid overload
✔️ Make more targeted resuscitation decisions

But keep in mind:

Study was in healthy, anesthetized dogs
Not yet validated in real clinical patients
Should not replace clinical judgment

Study cited in comments:

04/10/2026

🧐Is gabapentin ever actually managing your patient’s pain?

💊It’s one of the most commonly prescribed drugs in veterinary medicine right now — but the evidence for using it as a sole analgesic in dogs and cats is remarkably thin.

☝🏼It still has a role — for neuropathic pain, anxiolysis, and as part of a thoughtful multimodal plan. But as the primary analgesic sent home for acute pain? Let’s end this trend ASAP!

❓So why has it become a go-to prescription for acute pain in dogs and cats?
❓And if not Gabapentin, then what?
😻Stay tuned for my next post where I address these questions and more!

📌 Save this post and share it with your team
💙Visit mindfulvet.co to learn more about how I can help your team better understand and elevate your anesthesia and pain mgmt practices!

References:
Patel R & Dickenson AH. Mechanisms of the gabapentinoids and α2δ-1 calcium channel subunit in neuropathic pain. Pharmacology Research & Perspectives. 2016.
Pypendop BH, Siao KT, Ilkiw JE. Thermal antinociceptive effect of orally administered gabapentin in healthy cats. Am J Vet Res. 2010;71(9):1027-32.
Aghighi SA et al. Assessment of the influence of gabapentin on postoperative pain after intervertebral disc surgery in dogs. Vet Anaesth Analg. 2012;39(6):636-46.
Steagall PV, Benito J, Monteiro BP et al. Analgesic effects of gabapentin and buprenorphine in cats undergoing ovariohysterectomy: a randomized clinical trial. J Feline Med Surg. 2018;20(8):741-748.
Monteiro BP et al. 2022 WSAVA guidelines for the recognition, assessment and treatment of pain. J Small Anim Pract. 2023;64(4):177-254.
Giordano T et al. Gabapentin: Clinical Use and Pharmacokinetics in Dogs, Cats, and Horses. Animals. 2023;13(12):2045.
Wagner A, Mich P, Uhrig S, Hellyer P. Clinical evaluation of perioperative administration of gabapentin as an adjunct for postoperative analgesia in dogs undergoing amputation of a forelimb. J Am Vet Med Assoc. 2010;236(7):751-756.

04/07/2026

🥴 25+ years working in vet med and I’m STILL having to have this conversation. And I’ll keep having it as long as I have to! I recently saw a popular account post about Butorphanol the other day and the word analgesia was used WAY too many times than I was comfortable with. Time for a counter post with some references 📉

Butorphanol is a kappa opioid agonist and a mu opioid antagonist. This mixed agonist-antagonist profile is at the heart of its analgesic limitations. Kappa receptors provide only mild to maybe moderate analgesia, while mu receptors — where pure opioids like morphine, hydromorphone, and fentanyl act — provide moderate to heavy analgesia.

Research consistently shows butorphanol’s analgesic window is brief making it poorly suited for post-operative pain management without frequent redosing.

Butorphanol has a well-documented ceiling effect, meaning increasing the dose does not proportionally increase analgesia. This further limits its utility in moderate to severe pain scenarios.

Perhaps most clinically significant: there is research suggesting that butorphanol and its metabolites (hydroxybutorphanol and norbutorphanol) may occupy opioid receptors for up to 8 hours — with no analgesic benefit — essentially blocking more effective opioids from working during that window. This is a major concern when transitioning to pure mu agonists post-operatively.

A study in cats found that buprenorphine provided adequate analgesia for 6 hours following ovariohysterectomy, while butorphanol did not. In dogs, meloxicam produced significantly lower pain scores than butorphanol in the first 12 hours post-surgery.

A new 2025 study found that target-controlled infusions of butorphanol actually worsened hemodynamics in isoflurane-anesthetized cats — adding another layer of caution around its intraoperative use.

The current body of evidence suggests butorphanol has a limited role in analgesia for dogs and cats. It remains useful for sedation protocols and respiratory crisis but for meaningful perioperative pain management, pure mu agonists are far better supported by the literature.

Don’t have a pure mu? Consider Buprenorphine alongside Ketamine, Local blocks, and Nsaids for moderate-severe pain along with gentle tissue handling techniques and anxiolytics when appropriate!

References:
Opioid receptor interactions of butorphanol and its metabolites — PubMed (1983)
Dosing protocols to increase the efficacy of butorphanol in dogs — PMC
Evaluation of perioperative analgesic efficacy of buprenorphine vs butorphanol in cats — JAVMA
Target-controlled infusions of butorphanol worsen hemodynamics in isoflurane-anesthetized cats — Frontiers in Veterinary Science (2025)
Dosing protocols to increase the efficacy of butorphanol in dogs — PMC
Comparison of analgesic effects of butorphanol vs meloxicam after ovariohysterectomy in dogs — PMC
https://www.veterinaryanesthesianerds.com/blog/butorphanol-sostickyitsucks -(Not a paper, but a great discussion on the receptor debate with more studies!)