CASE IN POINT  h  BEHAVIOR  h  PEER REVIEWED

Chill Protocol
to Manage
Aggressive &
Fearful Dogs
Renata S. Costa, DVM, MPhil,
MANZCVS, GradDipEd
Alicia Z. Karas, DVM, MS, DACVAA
Stephanie Borns-Weil, DVM, DACVB
Cummings School of Veterinary Medicine
at Tufts University

Trotman, a 10-year-old, 100.3-lb (45.5-kg), toward team members. Thus, the Chill Protocol* to be
administered at home prior to Trotman’s follow-up appoint-
neutered male German shepherd dog, was ment was prescribed to decrease patient and owner stress
presented for oral examination after the
owners noted blood in his mouth. No other
apparent health problems were reported. TREATMENT AT A GLANCE: CHILL PROTOCOL
h Gabapentin (20-25 mg/kg PO) should be administered the evening
Physical Examination before the scheduled appointment.
The physical examination was limited due to fear-
h A combination of gabapentin (20-25 mg/kg PO) and melatonin
induced aggression, which was demonstrated by
(small dogs, 0.5-1 mg PO; medium dogs, 1-3 mg PO; large dogs,
Trotman’s low body posture, tucked tail, growling,
5 mg PO) should be administered at least 1 to 2 hours before the
and lunging when approached by team members.
scheduled appointment.
His owners were able to open his mouth and allow
h Acepromazine (0.025-0.05 mg/kg OTM) should be administered
visualization of a 2-cm mass in the buccal tissue at
the level of the right 3rd molar. 30 minutes before the scheduled appointment.

*The Chill Protocol is a relaxation protocol developed to manage fearful and aggressive
Oral examination, thoracic radiography, abdomi- dogs branded by the authors at Cummings School of Veterinary Medicine at Tufts University,
where it has been routinely administered to dogs and cats prior to medical appointments
nal ultrasonography, and resection/biopsy of the and to facilitate anesthesia since 2014.
mass were recommended but could not be per-
OTM = oral transmucosal
formed due to Trotman’s fear-induced aggression

May 2019    cliniciansbrief.com    63

CASE IN POINT  h  BEHAVIOR  h  PEER REVIEWED

levels and allow team members to safely handle supports its use. Melatonin is a naturally occurring
the patient for diagnostic investigation of the hormone produced by the pineal gland. Exogenous
mass. melatonin has been shown to reduce pre- and post-
operative anxiety in humans,6,7 and its calming
Chill Protocol effects and overall safety may benefit dogs with
The Chill Protocol is a combination of orally fear-motivated aggression and/or anxiety. Ace-
administered medications to facilitate procedural promazine elicits behavior-modifying effects (ie,
management of animals that exhibit signs of anxi- tranquilization, sedation) in animals and has syn-
ety and/or aggression. The protocol consists of ergistic effects with other sedatives, anxiolytics,
at-home administration of gabapentin, melatonin, and opioids that produce calming effects.8,9
and oral transmucosal (OTM) acepromazine (10
mg/mL injectable formulation) prior to a medical Trotman received gabapentin (22 mg/kg PO) the
appointment (see Treatment at a Glance: Chill night before his follow-up appointment and a com-
Protocol, previous page). Gabapentin and mela- bination of gabapentin (22 mg/kg PO), melatonin
tonin can be given with a small amount of food, and (5 mg PO), and acepromazine (0.04 mg/kg OTM)
acepromazine should be administered oral trans- at least 30 minutes prior to the appointment
mucosally via syringe for mucosal absorption. (Table). The timing of administration of the Chill
Protocol is essential, as it is important that medica-
Gabapentin has anxiolytic, sedative, analgesic, tions take effect prior to the stimulation caused by
and anticonvulsive properties.1-5 Oral gabapentin the trip to the hospital. Trotman’s owners were
causes anxiolysis and sedation in humans and advised of the potential for mild-to-heavy sedation
reduces fear responses in cats.1-4 Although pub- and weakness or incoordination and the need for
lished data on gabapentin’s use for anxiolysis and supervision. The duration of sedation is variable but
sedation are lacking, anecdotal clinical experience can last up to 24 hours, which is normal and not
harmful, whereas severe stress can have lasting
effects and may leave a dog tired and depressed,
TABLE reduce immune function, and result in other physi-
cal sequelae following exposure to the stressor.10
CHILL PROTOCOL ADMINISTERED
TO TROTMAN (100.3 LB [45.5 KG]) Outcome
Trotman arrived at the hospital moderately
sedated and ataxic but still ambulatory and wear-
ing a muzzle. He gave a low growl in response to
Drug Evening 1 to 2 Hours 30 Minutes
Prior to Prior to Prior to team members entering the examination room.
Examination Examination Arrival for Hydromorphone (0.1 mg/kg IM) was adminis-
(Dose) (Dose) Examination tered while Trotman was under minor restraint,
(Dose) and the muzzle was removed in case of vomiting.
He was left in the examination room with the own-
Gabapentin 1000 mg PO 1000 mg PO –
ers for 20 minutes while the hydromorphone took
Melatonin – 5 mg PO – effect (sedation should be deep enough to allow
further manipulations to be performed without
Injectable
– – 2 mg OTM the patient struggling). An intravenous catheter
acepromazine
was then easily placed in a lateral saphenous
vein while Trotman was conscious but sedate. He
offered no resistance to being remuzzled, lifted to
OTM = oral transmucosal
a gurney, and taken to radiology, where he was

64    cliniciansbrief.com    May 2019

positioned for thoracic radiography and subse-
quently transported to undergo ultrasonography. TAKE-HOME MESSAGES
An hour later, Trotman was induced with propofol
(1.5 mg/kg), intubated, and anesthetized with h The Chill Protocol aids in reducing fear, anxiety, and

sevoflurane for oral examination and dental pro- aggressive behavior in animals to facilitate safer, less
cedures, which were performed over the course of stressful handling during physical examinations, blood
draws, and noninvasive diagnostic procedures.
2 hours. Vital parameters remained within normal
limits. Recovery from anesthesia was uneventful. h Additional injectable drugs (eg, opioids, α2 agonists,

Owners continued administration of the Chill Pro- anesthetics) are often required to provide adequate
tocol for subsequent medical appointments due to analgesia and sedation for certain patients or more
its calming effects, with no adverse events noted at invasive procedures.
home or in the hospital. h The prescribing clinician is responsible for awareness

of the patient’s general health condition and when

Conclusion Chill Protocol administration might be contraindicated
The Chill Protocol provided adequate anxiolysis or require administration at a lower dose.
and sedation to allow for safe management of a dog h Chill Protocol duration is approximately 4 to 6 hours.

with fear-induced aggression without significant Redosing may be required if the patient is not
side effects. The Chill Protocol can be prescribed to expected at the hospital until later or remains at the
healthy patients that are known to be aggressive, hospital all day.
fearful, and/or anxious during hospital visits (see h Timing of drug administration and owner compliance
Take-Home Messages). are essential for successful treatment. n

The timing of administration of the Chill Protocol is essential,

as it is important that medications take effect prior to the
stimulation caused by the trip to the hospital.

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