November 12, 2025 • 20 mins
Horses and anesthesia make for a high stakes mix, and the numbers prove it. We open the barn door on a new study of oral trazodone in healthy adult horses that boosted sedation but, at a low dose, unexpectedly increased xylazine requirements at induction. Our award-winning guest, Dr. Emmett Swanton, walks us through the why behind the work, what the data actually say, and how to turn mixed results into smarter, safer protocols.
We dig into the global context first: equine perioperative mortality remains several times higher than in small animals, with most disasters happening during recovery. That’s where behavior, physiology, and pharmacology collide. Could a preoperative oral sedative soften the edges—calmer handling, smoother transitions, less panic? The study offers a nuanced yes: trazodone clearly increases calm, but clinicians shouldn’t assume an alpha-2 sparing effect at low dose. Instead, we talk practical use cases where trazodone shines today—pre-visit anxiolysis, postoperative stall rest—and where the next wave of research should go, especially recovery scoring and dose-timing strategies that might translate sedation into fewer complications.
Along the way, Emmett shares candid career lessons from residency to journal recognition and makes a compelling case for bridging small animal best practices to equine medicine without copy-pasting expectations. If you manage anxious horses, plan elective procedures, or obsess over safer recoveries, you’ll find concrete takeaways to test in your own barn: when to reach for trazodone, how to think about xylazine titration, and why the recovery phase deserves as much design as induction.
If this conversation helped you rethink your protocol, follow the show, share it with a colleague, and leave a quick review. Your feedback helps more veterinarians and horse owners find evidence-based strategies that keep horses safer.
AJVR article: https://doi.org/10.2460/ajvr.24.07.0185
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
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(00:22):
digestion, and more.
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Learn more at greenie.com.
SPEAKER_02 (00:35):
Welcome to Veterinary Vertex, the AVMA
Journal's podcast, where wedelve into behind-the-scenes
look with manuscript authors.
I'm editor-in-chief Lisa Fordi,joined by associate editor Sarah
Wright.
And today we're exploring howoral Trazodon results in
sedaceum, but it doesn't quiteresult in a xylozine sparing
effect in horses.
With our Journal Award winner,Emmett Swanton.
SPEAKER_03 (01:01):
Yeah, thank you guys for having me.
Excited to be here.
Talk about all things horses.
SPEAKER_01 (01:06):
And before we dive in, could you share a little bit
about your background and whatbrought you to this project?
SPEAKER_03 (01:11):
Yeah.
So I am originally actually fromToronto, uh north of Toronto,
um, and did my DVM and undergradand rotating internship at the
Ontario Veterinary College inGuelph, Ontario.
Um, and then decided that it wastime to diversify the portfolio
a little bit.
Um, and then ended up at theUniversity of Wisconsin-Madison
(01:34):
for my anesthesia and analgesiacresidency.
Um, and then sort of prettycommon for specialty colleges,
but for the anesthesia college,we have to publish at least one
um primary paper.
So this was my resident project.
Um, there was a few options whenI was, you know, starting
residency, a few like projectsaround the go that I could have
(01:56):
jumped in on.
Um, but this equine one kind ofcaught my eye.
I come with like a large animalbackground.
Um originally growing up in thecountry, um, originally wanted
to be a cow vet, and then asveterinary medicine does, our
paths twist, turn, and 360, 180,whatever you want to call it,
and um ended up in anesthesia,but was excited to um work with
(02:17):
some large animals and do thisproject.
SPEAKER_02 (02:20):
Emma, your AG of our article describes how oral low
dose TAS might increase xylosinerequirements.
What was the motivation for thisproject?
SPEAKER_03 (02:29):
Yeah, so that's a great question.
And I think globally, like if wetake a step back and we look at
um equine general anesthesia ingeneral, I think if you pull up,
so every few years um across theboard, there's this big study
that comes out, and it's calledthe Confidential Inquiry into
Perioperative Equine Fatalities.
(02:50):
And it's kind of where we lookacross the globe, lots of
countries participate and wekind of assess like what's going
on in terms of perioperativefatality when in relation to
anesthesia with our equinepatients.
And um, most recently, um, wethe new one was just published
this spring in 2025 in VAA.
And what we found is prettyconsistently that the mortality
(03:13):
rate of horses undergoinggeneral anesthesia is about
1.2%.
So, and then if we break thatdown further, because obviously
colics are a big part of horsesgoing under anesthesia, but if
you kind of tease out the colicsand we look at just like even
healthy horses undergoingelective procedures, um, their
mortality rate is still about0.6%.
(03:34):
So it's really, really high whenif we look at a comparison in
this number to say smallanimals, um, what you'll find in
the new edition in Lum and Jonesis they do a really nice job of
like kind of summarizing all ofthe mortality studies in small
animal patients that we have outthere.
And again, there can be so muchvariety in of like what's
(03:54):
included in this, what'sincluded in that.
And kind of what they synthesizeit down to is that small animal
patients, dogs and cats,healthy, undergoing elective
general anesthesia, um, thatmortality range is about 0.05%
to 0.25%.
So, like a huge difference inthat our equine patients have a
lot higher risk of mortalityunder anesthesia.
(04:17):
Um and then we know that thebiggest time for our e-coine
patients to have a mortalityevent or to have complications
is definitely going to berecovery.
Um, because you know, we havethese big horses that, you know,
they have their fight or flightand they like their knee-jerk
reaction is to like fly up andget away from us.
(04:38):
Um, and then when they're underinhaling anesthesia, they have
like a lot of muscle relaxationand they're usually not steady
on their feet, and thatpredisposes them to myopathies,
fractures, all of these likereally horrible things that can
result in mortality and youknow, sometimes them having to
be euthanized in recovery.
So, what we typically do is thata lot of times our patients have
(04:59):
to be heavily sedated, e-coinpatients have to be heavily
sedated going into recovery.
And the idea is that we keepthem asleep under injectable,
and then they're gonna breatheoff that inhale, and then they
wake up with from an injectablerecovery, they wake up nicer.
So the idea with this study wasthat if we gave them trazodone
up front and we got them maybemore sedated preoperatively,
(05:22):
maybe they needed less drugs toget to that safe plane to induce
them, because obviously um weneed a horse to be very sedate
to be able to induce thembecause we use ketamine dazlam.
We don't want them to be excitedfrom the ketamine.
Um kind of our homeworkpre-operative sedative and
equine patients are alpha twos,which um I could go down a
(05:43):
rabbit hole about why we want toreduce the amount of alpha twos
we sometimes give our patients,but um, we won't do that.
And um, so trying to reduce thatup front, and then if the
trazodone sticks around and theycan recover better, the idea
would be that might help them aswell.
So that was kind of the thereasoning for doing this study
was seeing like where can wecontinue to improve this like
(06:05):
population of patients that's ata relatively high risk compared
to the other species that werenestizing.
SPEAKER_02 (06:11):
Is there evidence or clinical observations to suggest
this interaction between Trazand xylosine?
SPEAKER_03 (06:18):
So the one that so um obviously the signing, the
findings in our paper were thatwe had increased sedation
scores, but when we look at thelow dose um trazodone group,
they actually required morexylosine.
And there had been nothingpreviously published about that
out there in the literature.
I think this was there's verylimited studies about trazodone
(06:41):
and horses at the time of thiswhen we were doing our research.
And a lot of them just morefocused on like there was one
that like looked at how oftenthey were walking in their
stalls, if it was like good forK-dress.
There was like a study aboutusing it for opto exams.
So this really was like therewas nothing out there about the
drug interaction.
This was kind of the first ofits kind and the first of the
findings reported.
SPEAKER_02 (07:02):
So, what are the clinician anesthesiologists
surgeon takeaway from thisstudy?
SPEAKER_03 (07:07):
Yeah, I think that the great takeaways from this
would be that we definitely cansee an increase in sedations.
So I think there is a place forthis in our equine patients, and
especially postoperatively, ifyou want to put a patient on
cage rest um and stuff likethat.
I think that we there is a rolefor trazodone.
(07:29):
And I think, you know, oneaspect that our our study at
this time didn't really look atis the recovery.
And I feel like that's a wholeuntapped area that can be
explored.
And, you know, um, as aresident, we move on from where
we trained.
So I have like moved on from theuniversity, but um I know
there's like work on clinicalstudies there looking at like
(07:49):
recovery scorings and stuff likethat, with um horses getting
oral trazodone as like the nextsteps of like the foundation
this first paper laid down forthem.
So hopefully that will becontinued to find good results
and use.
SPEAKER_01 (08:03):
So, what are the key take-home messages you hope
veterinarians and clients willremember?
SPEAKER_03 (08:07):
Yeah, I think like the key, the key takeaways that
I hope people remember is that,you know, trazodone and
perioperative like oralsedatives um are not just for
our small animal patients.
I think, you know, cliniciansare really good in the small
animal world of like, you know,dogs and cats are coming in on
their Gab and Tras before theiranesthesia, before their visits,
and that's great.
And we that's great for thepatient anxiety, but also from
(08:30):
an anesthetic perspective, I canfind you lots of papers that
show you Trazodone Gabapentinare gonna reduce your propofol,
they're gonna reduce your gas.
So I think that we need to likeshift the mindset and remember
that we can also use those onour large animal patients, and
it can be beneficial too.
SPEAKER_02 (08:47):
It's not just the gas to the patient, it's the gas
in the environment as well.
SPEAKER_03 (08:51):
Exactly.
Yep.
SPEAKER_02 (08:52):
Yeah.
All right, let's shift and talkabout winning one of the AVMA
Journal Awards.
How did it feel, Emmett, whenyou found out you were nominated
and then you that you won anaward?
SPEAKER_03 (09:02):
Yeah, I was so excited.
I remember, I think like I hadjust started board study, so um
kind of a dark day.
You know, you're sitting at homefor weeks at a time, holed up
with textbooks and charts, andthen getting this email was like
so, so exciting.
I remember like the first peopleI texted was like my two faculty
who were on the paper with me,Carrie Schroeder and Becky
Johnson.
(09:23):
I was like, oh my God, look atthis.
This is so exciting.
So um, yeah, we all three of uswere super excited.
SPEAKER_02 (09:29):
Well, you already answered my next question, which
are the primary people that, youknow, the immediate ones you
want to reach out to.
Uh, and for other listeners, ifyou could go back and tell your
resident self or your studentsone thing about this journey
into residency, completing aproject, uh, getting it done,
designing the project, whatwould it be?
SPEAKER_03 (09:49):
Yeah, for sure.
I think, at least for me beforelike I went into it, I had this
like guised or this idea thatlike research was like, you
know, scientists sitting attheir lab benches or sitting in
labs in white coats, um, andthat like it wasn't fun.
Um, and that some of thoseresults like weren't necessarily
applicable or like had likeclinical relevance.
(10:09):
Um, so I think like what thisstudy showed me that you know,
research can be fun.
Like I said, like uh myself andthe two other faculty, you know,
we spent days at the barn withthe teaching horses.
We were having a grand old time,um, you know, hanging out.
So it was lots of fun.
You know, the sedation score weused, like it's a validated
equine sedation score, and itinvolves like opening an
umbrella in front of the horses.
(10:30):
So like we're out there in themiddle of Wisconsin in the
winter, like opening umbrellasin front of horses.
So I mean, it was fun.
And then I think like theresults are really cool and
they're like applicable anduseful.
So I feel like I've talked tolike equine colleagues that are
like, hey, like we saw yourpaper and we like give our
patients trazodone and it's likethey're sedated, they send their
stalls.
So I think that's been likesuper rewarding and just like a
(10:53):
shift in mindset that I think umresearch can be fun and it can
find results that are actuallygonna hopefully improve things
for our patients.
SPEAKER_01 (11:02):
So I'm so glad you said that actually.
I have a friend who is a smallanimal general practitioner from
vet school, and I was gettingdinner with her this weekend,
and she was like, Sarah, I don'tknow how you do your job.
She's like, I could never dothat.
I'm like, no, it's not just likebench top research, and like
it's really cool advancementsand like getting to see that and
being at the forefront of thefield and advancing it.
Like that's how we learn what welearn in vet school, even it's
(11:22):
like what's in the literatureand what works.
So yeah, thank you for sharingthat with our listeners.
SPEAKER_03 (11:27):
Yeah, super cool.
SPEAKER_01 (11:29):
So, how has receiving this award influenced
your the research or your careersince then?
SPEAKER_03 (11:34):
Yeah, I think um I think like um, like I said, like
I've left the university.
So not necessarily like in thehuge research um field right
now, but I think it's definitelylike opened my eyes that if
there is a time in my career,because the beautiful thing
about veterinary medicine islots of different avenues for us
to go down.
Um, that like I wouldn't beafraid or like be abrasive to
(11:55):
like going into a position oranother career path that
involves research.
Like I would love, you know, Ithink like large animal
patients, like they definitelyaren't don't get as much
attention as for the anesthesiafor research in general, but
especially anesthesia, that Iwould not hesitate at all to
like, you know, go worksomewhere and like you know, be
(12:16):
a large an equine anesthesiaresearcher or even, you know, a
bovine um equine, or I guess notequine, but a bovine anesthesia
researcher.
That's uh my Wisconsin comingout.
But uh yeah, I think it'sdefinitely like made me less
hesitant to like, you know, if Isee a job post and that requires
research to like, I'm notrunning away anymore, kind of
thing.
SPEAKER_01 (12:36):
And what advice would you give to other
researchers that are hoping tomake that kind of impact in
their own work?
SPEAKER_03 (12:42):
Yeah, I think like it's really important to find a
project that you're likepassionate about and that does
have clinical relevance.
Like, you know, I love largeanimals and I love anesthesia.
So the idea that I can maybeimprove ecoine anesthesia, even
if just a minuscule or even justbuilding a foundation for like
further clinical studies thatother people can go on and like
take kind of that torch to thenext step, um, is really
(13:05):
exciting.
Um, and I when you're passionateabout it, it's like not hard.
Like I was like, oh, I can writeand talk to anybody about e
horse anesthesia, like sign meup.
Um, so I think like that'sdefinitely really important.
SPEAKER_02 (13:19):
Yeah, but in in your uh career to date, were there
any pivotal moments orchallenges uh that really shaped
your path?
SPEAKER_03 (13:27):
Yeah, I think like if I obviously, you know, being
a someone in a specialty, Ithink there's always like that
pivotal moment that we likethink about like the day we
actually like were locked inthat I was like, this is what I
want to do.
And for me, like it's actuallyrelated to being a vet student.
Um so like I'd said I was astudent at OVC and uh originally
(13:47):
like thought that I wanted to becow vet, and then I like spent
uh a win some time in a winterin Ontario with a large animal
vet, and I was like, oh my god.
I was like, one arm is warm, butthat's not for me.
Like I can't do that.
Um then I yeah, so then I um waslike, oh, maybe I'll do critical
care, like we'll do somethingexciting.
And um there was a criticalistthat had like taught taught us
(14:09):
in our DVM program um since kindof like day one.
And I just remember like Ithought she was so cooler.
Um, Dr.
Bersanis, Lexa Bersanus, and shewas like just like made
everything fun.
And so I'd reached out to herand I was like, hey, like I
think I want to do um ICU, likeany summer job opportunities
research, like what would whatwould you recommend I do?
(14:30):
And um at OVC they hired twosummer students to work in the
anesthesia department, and shewas like, I would go work in the
anesthesia department, you'regonna get a see a bunch, do all
these like clinical cases.
Um so then she sent me to theanesthesia department and I
never looked back.
Um, I do remind her that whenshe's always like, Yeah, you
ditched me for critical care.
(14:50):
And I'm like, uh nope, you'rethe one who sent me to
anesthesia, so it's your ownfault.
But yeah, I think that was likea pretty pivotal moment where I
was like, you know, if I don'tthink she'd pushed me to
anesthesia, I don't know if Iwould have found it.
Um, but happy I did.
Love, love what I do.
SPEAKER_02 (15:06):
It's such a great career in veterinary medicine.
There's so many options.
SPEAKER_03 (15:10):
Yeah.
SPEAKER_02 (15:11):
What going back a little bit further?
What first sparked your interestin veterinary medicine and
ultimately led to where you aretoday?
SPEAKER_03 (15:17):
Yeah, I think um, so I growing up like north of
Toronto was kind of ruralOntario.
I was like in immersed and umvery much like agriculture.
That's actually what myundergrad is in.
I showed beef cows growing up, Iworked on dairy farms.
So like I was like locked in,gonna, you know, be a part of
this agri-food system, um, whichI think all those veterinarians
(15:41):
are very smart and very thankfulthat they're there.
Um, so that's like kind of whathad started me on this journey
is I was like, oh, I see a role,I see a need for like rural
veterinarians.
Um, and that's like what my planis gonna be.
But um, the twists and turns hadother, other things in store,
but it definitely was like thoseearly experiences of like
working with cattle and stufflike that that was like
(16:04):
influenced me to go into thisthis career.
SPEAKER_01 (16:06):
So, Emmett, what is one piece of information the
veterinarians should know aboutusing oral trazodone in healthy
adult horses?
SPEAKER_03 (16:14):
Yeah, I think like the one simple piece of
information they should rememberis that oral trazodone in horses
works and that we should beusing it and incorporating it um
in for our equine patients.
SPEAKER_01 (16:29):
And for clients, what's one thing you wish more
horse owners understood aboutthis topic?
SPEAKER_03 (16:34):
Yeah, I think that I wish more horses um owners
understood that there are likeother options in terms of just
our conventional, you know,xylazine, academy medazle and
xylosine and recovery, and thatthere are lots of things that we
can do.
Um, and lots of and otheroptions other than domator gel
(16:57):
for your anxious horses that youstay in a stall.
Um, that we have other things inour toolbox and don't be afraid
to ask your veterinarians forthem or um you know open that
conversation for sure.
SPEAKER_02 (17:09):
All right, Emmett, before we wrap up, we're gonna
have a little fun.
First, I need to know do youhave a pet?
SPEAKER_03 (17:15):
Um, so I did uh um the very classic thing of I got
a German throat hair pointerduring COVID that I love dearly.
Um, but I don't think she wasshe wasn't made for residency
life.
She was made for living out inthe country at my parents'
house.
So I have a dog that I I pay allthe bills for, but um, she
(17:36):
resides in rural Ontario quitecontently.
SPEAKER_02 (17:39):
If she could describe you in three words,
what would she say?
SPEAKER_03 (17:43):
Yeah, I think that she would honestly think I'm
pretty annoying.
I love to bug her.
Um that I also was this I'm thesnack police in the household,
and that's probably theveterinarian in me that I'm
like, yeah, you don't needanymore.
Um, and also the bed hogger,even though I would argue she's
the bed hogger, I'm I'm sure inher mind that when I'm at home
and we're sharing a bed, shereally wishes I would leave.
SPEAKER_02 (18:07):
Are you a coffee before rounds person or a coffee
all day person, or are you acoffee person?
SPEAKER_03 (18:13):
I am a black coffee all day, every day person.
SPEAKER_02 (18:18):
No cutoff point?
SPEAKER_03 (18:19):
Nope.
SPEAKER_02 (18:20):
Any special brand you like, best of all?
SPEAKER_03 (18:23):
Um honestly, as long as it's hot and it's black and
it's full of caffeine, I amthere.
SPEAKER_02 (18:30):
All right.
Do you carry a thermos around soyou can have it hot all day, or
where do you get your coffee allday?
SPEAKER_03 (18:35):
Um, so we used to have what we call the jailhouse
coffee machine at Wisconsin.
That was like this free coffeemachine that had horribly
tasting coffee, but it was thereall day and it was free.
So that was a pretty commonplace.
Um, but yeah, otherwise, youknow, I have drag around a yeti
that keeps it pretty warm mostof the day.
SPEAKER_02 (18:56):
Of course.
Um, you know, we talk a lotabout wellness and work-life
balance in veterinary medicine.
So, what's your go-to stressrelief after a long day and even
over the weekend?
SPEAKER_03 (19:06):
Yeah, my um, well, I'm a big like get up and go to
the gym before work person.
So I am one of those like scarypeople that's getting up at 4
a.m., going to the gym before Ieven get to the hospital.
And that was like alterresidency, something I've
carried into now privatepractice life.
Things just very important tomove our bodies.
Um, but if like my guiltypleasure is um ved being uh
(19:30):
vegetating on the couch, umwatching reality TV, especially
um like real housewives of SaltLake City.
That's where you're gonna catchme nine times out of ten.
That's awesome.
SPEAKER_01 (19:40):
I love that.
Ahmed, do you watch baseball?
SPEAKER_03 (19:44):
I was like a bandwagoner because I know the
blue jays.
Yeah.
Um, as a Canadian, I have to,you know, support the Blue Jays.
SPEAKER_01 (19:52):
So that's all I'm asking.
SPEAKER_03 (19:53):
Yeah.
For about like the last week,I've understood what's happening
with the Blue Jays, but that'sabout it.
SPEAKER_01 (19:59):
Yeah, I was gonna say sorry for your loss.
You watched the game onSaturday.
We were we were winning for theBlue Jays as well.
The daughters got their time.
Well, Emmett, thank you so muchfor joining us.
You really appreciate you beinghere with us today.
SPEAKER_03 (20:11):
Yeah, thank you guys for having me.
This has been great.
SPEAKER_01 (20:13):
And for our listeners, you can read Emmett's
award-winning article in AJVR.
I'm Sarah Wright here at LisaFortier.
Be sure to tune in next week foranother episode of Veterinary
Vertex.
And don't forget to leave us arating and review on Apple
Podcasts or wherever you listen.
From the makers of FET recommended Green East
Dental Freeze, comes an easy wayto support your dad wellness.
Green East Smart Essentials, DryFood Delivered, and Fleet
Balance Nutrition with ScienceBack Recipes.
GreenEats Supplement, developedby a team of PhD animal
nutritionists, offers options tohelp support healthy joints,
(00:22):
digestion, and more.
Whether it's meal time ormobility support, Greenece helps
you care for your dog from theinside out.
Learn more at greenie.com.
SPEAKER_02 (00:35):
Welcome to Veterinary Vertex, the AVMA
Journal's podcast, where wedelve into behind-the-scenes
look with manuscript authors.
I'm editor-in-chief Lisa Fordi,joined by associate editor Sarah
Wright.
And today we're exploring howoral Trazodon results in
sedaceum, but it doesn't quiteresult in a xylozine sparing
effect in horses.
With our Journal Award winner,Emmett Swanton.
SPEAKER_03 (01:01):
Yeah, thank you guys for having me.
Excited to be here.
Talk about all things horses.
SPEAKER_01 (01:06):
And before we dive in, could you share a little bit
about your background and whatbrought you to this project?
SPEAKER_03 (01:11):
Yeah.
So I am originally actually fromToronto, uh north of Toronto,
um, and did my DVM and undergradand rotating internship at the
Ontario Veterinary College inGuelph, Ontario.
Um, and then decided that it wastime to diversify the portfolio
a little bit.
Um, and then ended up at theUniversity of Wisconsin-Madison
(01:34):
for my anesthesia and analgesiacresidency.
Um, and then sort of prettycommon for specialty colleges,
but for the anesthesia college,we have to publish at least one
um primary paper.
So this was my resident project.
Um, there was a few options whenI was, you know, starting
residency, a few like projectsaround the go that I could have
(01:56):
jumped in on.
Um, but this equine one kind ofcaught my eye.
I come with like a large animalbackground.
Um originally growing up in thecountry, um, originally wanted
to be a cow vet, and then asveterinary medicine does, our
paths twist, turn, and 360, 180,whatever you want to call it,
and um ended up in anesthesia,but was excited to um work with
(02:17):
some large animals and do thisproject.
SPEAKER_02 (02:20):
Emma, your AG of our article describes how oral low
dose TAS might increase xylosinerequirements.
What was the motivation for thisproject?
SPEAKER_03 (02:29):
Yeah, so that's a great question.
And I think globally, like if wetake a step back and we look at
um equine general anesthesia ingeneral, I think if you pull up,
so every few years um across theboard, there's this big study
that comes out, and it's calledthe Confidential Inquiry into
Perioperative Equine Fatalities.
(02:50):
And it's kind of where we lookacross the globe, lots of
countries participate and wekind of assess like what's going
on in terms of perioperativefatality when in relation to
anesthesia with our equinepatients.
And um, most recently, um, wethe new one was just published
this spring in 2025 in VAA.
And what we found is prettyconsistently that the mortality
(03:13):
rate of horses undergoinggeneral anesthesia is about
1.2%.
So, and then if we break thatdown further, because obviously
colics are a big part of horsesgoing under anesthesia, but if
you kind of tease out the colicsand we look at just like even
healthy horses undergoingelective procedures, um, their
mortality rate is still about0.6%.
(03:34):
So it's really, really high whenif we look at a comparison in
this number to say smallanimals, um, what you'll find in
the new edition in Lum and Jonesis they do a really nice job of
like kind of summarizing all ofthe mortality studies in small
animal patients that we have outthere.
And again, there can be so muchvariety in of like what's
(03:54):
included in this, what'sincluded in that.
And kind of what they synthesizeit down to is that small animal
patients, dogs and cats,healthy, undergoing elective
general anesthesia, um, thatmortality range is about 0.05%
to 0.25%.
So, like a huge difference inthat our equine patients have a
lot higher risk of mortalityunder anesthesia.
(04:17):
Um and then we know that thebiggest time for our e-coine
patients to have a mortalityevent or to have complications
is definitely going to berecovery.
Um, because you know, we havethese big horses that, you know,
they have their fight or flightand they like their knee-jerk
reaction is to like fly up andget away from us.
(04:38):
Um, and then when they're underinhaling anesthesia, they have
like a lot of muscle relaxationand they're usually not steady
on their feet, and thatpredisposes them to myopathies,
fractures, all of these likereally horrible things that can
result in mortality and youknow, sometimes them having to
be euthanized in recovery.
So, what we typically do is thata lot of times our patients have
(04:59):
to be heavily sedated, e-coinpatients have to be heavily
sedated going into recovery.
And the idea is that we keepthem asleep under injectable,
and then they're gonna breatheoff that inhale, and then they
wake up with from an injectablerecovery, they wake up nicer.
So the idea with this study wasthat if we gave them trazodone
up front and we got them maybemore sedated preoperatively,
(05:22):
maybe they needed less drugs toget to that safe plane to induce
them, because obviously um weneed a horse to be very sedate
to be able to induce thembecause we use ketamine dazlam.
We don't want them to be excitedfrom the ketamine.
Um kind of our homeworkpre-operative sedative and
equine patients are alpha twos,which um I could go down a
(05:43):
rabbit hole about why we want toreduce the amount of alpha twos
we sometimes give our patients,but um, we won't do that.
And um, so trying to reduce thatup front, and then if the
trazodone sticks around and theycan recover better, the idea
would be that might help them aswell.
So that was kind of the thereasoning for doing this study
was seeing like where can wecontinue to improve this like
(06:05):
population of patients that's ata relatively high risk compared
to the other species that werenestizing.
SPEAKER_02 (06:11):
Is there evidence or clinical observations to suggest
this interaction between Trazand xylosine?
SPEAKER_03 (06:18):
So the one that so um obviously the signing, the
findings in our paper were thatwe had increased sedation
scores, but when we look at thelow dose um trazodone group,
they actually required morexylosine.
And there had been nothingpreviously published about that
out there in the literature.
I think this was there's verylimited studies about trazodone
(06:41):
and horses at the time of thiswhen we were doing our research.
And a lot of them just morefocused on like there was one
that like looked at how oftenthey were walking in their
stalls, if it was like good forK-dress.
There was like a study aboutusing it for opto exams.
So this really was like therewas nothing out there about the
drug interaction.
This was kind of the first ofits kind and the first of the
findings reported.
SPEAKER_02 (07:02):
So, what are the clinician anesthesiologists
surgeon takeaway from thisstudy?
SPEAKER_03 (07:07):
Yeah, I think that the great takeaways from this
would be that we definitely cansee an increase in sedations.
So I think there is a place forthis in our equine patients, and
especially postoperatively, ifyou want to put a patient on
cage rest um and stuff likethat.
I think that we there is a rolefor trazodone.
(07:29):
And I think, you know, oneaspect that our our study at
this time didn't really look atis the recovery.
And I feel like that's a wholeuntapped area that can be
explored.
And, you know, um, as aresident, we move on from where
we trained.
So I have like moved on from theuniversity, but um I know
there's like work on clinicalstudies there looking at like
(07:49):
recovery scorings and stuff likethat, with um horses getting
oral trazodone as like the nextsteps of like the foundation
this first paper laid down forthem.
So hopefully that will becontinued to find good results
and use.
SPEAKER_01 (08:03):
So, what are the key take-home messages you hope
veterinarians and clients willremember?
SPEAKER_03 (08:07):
Yeah, I think like the key, the key takeaways that
I hope people remember is that,you know, trazodone and
perioperative like oralsedatives um are not just for
our small animal patients.
I think, you know, cliniciansare really good in the small
animal world of like, you know,dogs and cats are coming in on
their Gab and Tras before theiranesthesia, before their visits,
and that's great.
And we that's great for thepatient anxiety, but also from
(08:30):
an anesthetic perspective, I canfind you lots of papers that
show you Trazodone Gabapentinare gonna reduce your propofol,
they're gonna reduce your gas.
So I think that we need to likeshift the mindset and remember
that we can also use those onour large animal patients, and
it can be beneficial too.
SPEAKER_02 (08:47):
It's not just the gas to the patient, it's the gas
in the environment as well.
SPEAKER_03 (08:51):
Exactly.
Yep.
SPEAKER_02 (08:52):
Yeah.
All right, let's shift and talkabout winning one of the AVMA
Journal Awards.
How did it feel, Emmett, whenyou found out you were nominated
and then you that you won anaward?
SPEAKER_03 (09:02):
Yeah, I was so excited.
I remember, I think like I hadjust started board study, so um
kind of a dark day.
You know, you're sitting at homefor weeks at a time, holed up
with textbooks and charts, andthen getting this email was like
so, so exciting.
I remember like the first peopleI texted was like my two faculty
who were on the paper with me,Carrie Schroeder and Becky
Johnson.
(09:23):
I was like, oh my God, look atthis.
This is so exciting.
So um, yeah, we all three of uswere super excited.
SPEAKER_02 (09:29):
Well, you already answered my next question, which
are the primary people that, youknow, the immediate ones you
want to reach out to.
Uh, and for other listeners, ifyou could go back and tell your
resident self or your studentsone thing about this journey
into residency, completing aproject, uh, getting it done,
designing the project, whatwould it be?
SPEAKER_03 (09:49):
Yeah, for sure.
I think, at least for me beforelike I went into it, I had this
like guised or this idea thatlike research was like, you
know, scientists sitting attheir lab benches or sitting in
labs in white coats, um, andthat like it wasn't fun.
Um, and that some of thoseresults like weren't necessarily
applicable or like had likeclinical relevance.
(10:09):
Um, so I think like what thisstudy showed me that you know,
research can be fun.
Like I said, like uh myself andthe two other faculty, you know,
we spent days at the barn withthe teaching horses.
We were having a grand old time,um, you know, hanging out.
So it was lots of fun.
You know, the sedation score weused, like it's a validated
equine sedation score, and itinvolves like opening an
umbrella in front of the horses.
(10:30):
So like we're out there in themiddle of Wisconsin in the
winter, like opening umbrellasin front of horses.
So I mean, it was fun.
And then I think like theresults are really cool and
they're like applicable anduseful.
So I feel like I've talked tolike equine colleagues that are
like, hey, like we saw yourpaper and we like give our
patients trazodone and it's likethey're sedated, they send their
stalls.
So I think that's been likesuper rewarding and just like a
(10:53):
shift in mindset that I think umresearch can be fun and it can
find results that are actuallygonna hopefully improve things
for our patients.
SPEAKER_01 (11:02):
So I'm so glad you said that actually.
I have a friend who is a smallanimal general practitioner from
vet school, and I was gettingdinner with her this weekend,
and she was like, Sarah, I don'tknow how you do your job.
She's like, I could never dothat.
I'm like, no, it's not just likebench top research, and like
it's really cool advancementsand like getting to see that and
being at the forefront of thefield and advancing it.
Like that's how we learn what welearn in vet school, even it's
(11:22):
like what's in the literatureand what works.
So yeah, thank you for sharingthat with our listeners.
SPEAKER_03 (11:27):
Yeah, super cool.
SPEAKER_01 (11:29):
So, how has receiving this award influenced
your the research or your careersince then?
SPEAKER_03 (11:34):
Yeah, I think um I think like um, like I said, like
I've left the university.
So not necessarily like in thehuge research um field right
now, but I think it's definitelylike opened my eyes that if
there is a time in my career,because the beautiful thing
about veterinary medicine islots of different avenues for us
to go down.
Um, that like I wouldn't beafraid or like be abrasive to
(11:55):
like going into a position oranother career path that
involves research.
Like I would love, you know, Ithink like large animal
patients, like they definitelyaren't don't get as much
attention as for the anesthesiafor research in general, but
especially anesthesia, that Iwould not hesitate at all to
like, you know, go worksomewhere and like you know, be
(12:16):
a large an equine anesthesiaresearcher or even, you know, a
bovine um equine, or I guess notequine, but a bovine anesthesia
researcher.
That's uh my Wisconsin comingout.
But uh yeah, I think it'sdefinitely like made me less
hesitant to like, you know, if Isee a job post and that requires
research to like, I'm notrunning away anymore, kind of
thing.
SPEAKER_01 (12:36):
And what advice would you give to other
researchers that are hoping tomake that kind of impact in
their own work?
SPEAKER_03 (12:42):
Yeah, I think like it's really important to find a
project that you're likepassionate about and that does
have clinical relevance.
Like, you know, I love largeanimals and I love anesthesia.
So the idea that I can maybeimprove ecoine anesthesia, even
if just a minuscule or even justbuilding a foundation for like
further clinical studies thatother people can go on and like
take kind of that torch to thenext step, um, is really
(13:05):
exciting.
Um, and I when you're passionateabout it, it's like not hard.
Like I was like, oh, I can writeand talk to anybody about e
horse anesthesia, like sign meup.
Um, so I think like that'sdefinitely really important.
SPEAKER_02 (13:19):
Yeah, but in in your uh career to date, were there
any pivotal moments orchallenges uh that really shaped
your path?
SPEAKER_03 (13:27):
Yeah, I think like if I obviously, you know, being
a someone in a specialty, Ithink there's always like that
pivotal moment that we likethink about like the day we
actually like were locked inthat I was like, this is what I
want to do.
And for me, like it's actuallyrelated to being a vet student.
Um so like I'd said I was astudent at OVC and uh originally
(13:47):
like thought that I wanted to becow vet, and then I like spent
uh a win some time in a winterin Ontario with a large animal
vet, and I was like, oh my god.
I was like, one arm is warm, butthat's not for me.
Like I can't do that.
Um then I yeah, so then I um waslike, oh, maybe I'll do critical
care, like we'll do somethingexciting.
And um there was a criticalistthat had like taught taught us
(14:09):
in our DVM program um since kindof like day one.
And I just remember like Ithought she was so cooler.
Um, Dr.
Bersanis, Lexa Bersanus, and shewas like just like made
everything fun.
And so I'd reached out to herand I was like, hey, like I
think I want to do um ICU, likeany summer job opportunities
research, like what would whatwould you recommend I do?
(14:30):
And um at OVC they hired twosummer students to work in the
anesthesia department, and shewas like, I would go work in the
anesthesia department, you'regonna get a see a bunch, do all
these like clinical cases.
Um so then she sent me to theanesthesia department and I
never looked back.
Um, I do remind her that whenshe's always like, Yeah, you
ditched me for critical care.
(14:50):
And I'm like, uh nope, you'rethe one who sent me to
anesthesia, so it's your ownfault.
But yeah, I think that was likea pretty pivotal moment where I
was like, you know, if I don'tthink she'd pushed me to
anesthesia, I don't know if Iwould have found it.
Um, but happy I did.
Love, love what I do.
SPEAKER_02 (15:06):
It's such a great career in veterinary medicine.
There's so many options.
SPEAKER_03 (15:10):
Yeah.
SPEAKER_02 (15:11):
What going back a little bit further?
What first sparked your interestin veterinary medicine and
ultimately led to where you aretoday?
SPEAKER_03 (15:17):
Yeah, I think um, so I growing up like north of
Toronto was kind of ruralOntario.
I was like in immersed and umvery much like agriculture.
That's actually what myundergrad is in.
I showed beef cows growing up, Iworked on dairy farms.
So like I was like locked in,gonna, you know, be a part of
this agri-food system, um, whichI think all those veterinarians
(15:41):
are very smart and very thankfulthat they're there.
Um, so that's like kind of whathad started me on this journey
is I was like, oh, I see a role,I see a need for like rural
veterinarians.
Um, and that's like what my planis gonna be.
But um, the twists and turns hadother, other things in store,
but it definitely was like thoseearly experiences of like
working with cattle and stufflike that that was like
(16:04):
influenced me to go into thisthis career.
SPEAKER_01 (16:06):
So, Emmett, what is one piece of information the
veterinarians should know aboutusing oral trazodone in healthy
adult horses?
SPEAKER_03 (16:14):
Yeah, I think like the one simple piece of
information they should rememberis that oral trazodone in horses
works and that we should beusing it and incorporating it um
in for our equine patients.
SPEAKER_01 (16:29):
And for clients, what's one thing you wish more
horse owners understood aboutthis topic?
SPEAKER_03 (16:34):
Yeah, I think that I wish more horses um owners
understood that there are likeother options in terms of just
our conventional, you know,xylazine, academy medazle and
xylosine and recovery, and thatthere are lots of things that we
can do.
Um, and lots of and otheroptions other than domator gel
(16:57):
for your anxious horses that youstay in a stall.
Um, that we have other things inour toolbox and don't be afraid
to ask your veterinarians forthem or um you know open that
conversation for sure.
SPEAKER_02 (17:09):
All right, Emmett, before we wrap up, we're gonna
have a little fun.
First, I need to know do youhave a pet?
SPEAKER_03 (17:15):
Um, so I did uh um the very classic thing of I got
a German throat hair pointerduring COVID that I love dearly.
Um, but I don't think she wasshe wasn't made for residency
life.
She was made for living out inthe country at my parents'
house.
So I have a dog that I I pay allthe bills for, but um, she
(17:36):
resides in rural Ontario quitecontently.
SPEAKER_02 (17:39):
If she could describe you in three words,
what would she say?
SPEAKER_03 (17:43):
Yeah, I think that she would honestly think I'm
pretty annoying.
I love to bug her.
Um that I also was this I'm thesnack police in the household,
and that's probably theveterinarian in me that I'm
like, yeah, you don't needanymore.
Um, and also the bed hogger,even though I would argue she's
the bed hogger, I'm I'm sure inher mind that when I'm at home
and we're sharing a bed, shereally wishes I would leave.
SPEAKER_02 (18:07):
Are you a coffee before rounds person or a coffee
all day person, or are you acoffee person?
SPEAKER_03 (18:13):
I am a black coffee all day, every day person.
SPEAKER_02 (18:18):
No cutoff point?
SPEAKER_03 (18:19):
Nope.
SPEAKER_02 (18:20):
Any special brand you like, best of all?
SPEAKER_03 (18:23):
Um honestly, as long as it's hot and it's black and
it's full of caffeine, I amthere.
SPEAKER_02 (18:30):
All right.
Do you carry a thermos around soyou can have it hot all day, or
where do you get your coffee allday?
SPEAKER_03 (18:35):
Um, so we used to have what we call the jailhouse
coffee machine at Wisconsin.
That was like this free coffeemachine that had horribly
tasting coffee, but it was thereall day and it was free.
So that was a pretty commonplace.
Um, but yeah, otherwise, youknow, I have drag around a yeti
that keeps it pretty warm mostof the day.
SPEAKER_02 (18:56):
Of course.
Um, you know, we talk a lotabout wellness and work-life
balance in veterinary medicine.
So, what's your go-to stressrelief after a long day and even
over the weekend?
SPEAKER_03 (19:06):
Yeah, my um, well, I'm a big like get up and go to
the gym before work person.
So I am one of those like scarypeople that's getting up at 4
a.m., going to the gym before Ieven get to the hospital.
And that was like alterresidency, something I've
carried into now privatepractice life.
Things just very important tomove our bodies.
Um, but if like my guiltypleasure is um ved being uh
(19:30):
vegetating on the couch, umwatching reality TV, especially
um like real housewives of SaltLake City.
That's where you're gonna catchme nine times out of ten.
That's awesome.
SPEAKER_01 (19:40):
I love that.
Ahmed, do you watch baseball?
SPEAKER_03 (19:44):
I was like a bandwagoner because I know the
blue jays.
Yeah.
Um, as a Canadian, I have to,you know, support the Blue Jays.
SPEAKER_01 (19:52):
So that's all I'm asking.
SPEAKER_03 (19:53):
Yeah.
For about like the last week,I've understood what's happening
with the Blue Jays, but that'sabout it.
SPEAKER_01 (19:59):
Yeah, I was gonna say sorry for your loss.
You watched the game onSaturday.
We were we were winning for theBlue Jays as well.
The daughters got their time.
Well, Emmett, thank you so muchfor joining us.
You really appreciate you beinghere with us today.
SPEAKER_03 (20:11):
Yeah, thank you guys for having me.
This has been great.
SPEAKER_01 (20:13):
And for our listeners, you can read Emmett's
award-winning article in AJVR.
I'm Sarah Wright here at LisaFortier.
Be sure to tune in next week foranother episode of Veterinary
Vertex.
And don't forget to leave us arating and review on Apple
Podcasts or wherever you listen.
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