Anxiety is the uncertainty and fear that result from anticipation of a real or imaginary threat and often impairs physical and psychological functioning. Clinical signs include vocalization, panting, and restlessness.15
Patients in which adequate pain management has been implemented but persistent vocalization and restlessness continues may be experiencing fear, stress, and/or anxiety. Administration of a tranquilizer or sedative (eg, acepromazine [0.01 mg/kg IV], dexmedetomidine [0.001 mg/kg IV]; cats and dogs) can be considered if there are no contraindications (eg, previous allergic reaction to the agent, patient is hypovolemic)4,7; however, some dogs and cats may only have a temporary response. In these cases, especially if restlessness is due to anxiety, agents such as trazodone (3-10 mg/kg PO) or gabapentin (10-25 mg/kg PO) can be administered. The patient will need to be reassessed after initial treatment, as some patients may require higher doses of these agents. The aim, however, should be to administer the lowest dose possible to minimize the risk for adverse effects while still achieving the desired outcome. Trazodone enhances calmness, reduces anxiety, and produces mild sedation with no apparent relevant adverse effects in dogs.16,17
Patients that are anxious may respond to being held, but this is not always feasible. Nonpharmacologic alternatives include anxiety or pressure wraps (eg, a thunder jacket) that maintain swaddling pressure and acupressure aimed to induce calmness.18,19