Severe FAS and signs of aggression require which approach?

• A. more potent drugs
• B. add ketamine or tiletamine-zolazepam to opioid and alpha-2 agonist
• C. both A and B
• D. none

Answer: (C)

When a patient is severely fearful and aggressive, you need a deeper, multi-modal plan to ensure safety and welfare. Using a more potent baseline drug captures the need for stronger sedation, analgesia, and disassociation. Adding a dissociative agent such as ketamine or tiletamine-zolazepam to an opioid and an alpha-2 agonist provides robust analgesia, amnesia, and immobilization, while complementing the sedative and muscle-relaxant effects. Ketamine, in particular, helps preserve airway reflexes and cardiovascular stability to some extent, which is useful when the animal is at risk from stress and struggle, whereas tiletamine-zolazepam offers reliable dissociative anesthesia with benzodiazepine-type sedation. Together, this combination addresses pain, fear, and aggression more effectively than a single agent, improving safety for both the patient and staff. Monitor closely for cardiovascular and respiratory effects and tailor dosing to the individual animal.