Alfaxalone (Alfaxan)

Alfaxalone, marketed under the brand name Alfaxan, is a neuroactive steroid anesthetic agent that has become increasingly popular in veterinary medicine for anesthesia induction and maintenance of short procedures in dogs. This injectable anesthetic represents a modern formulation of a steroid-based anesthetic originally developed decades ago but reformulated with cyclodextrin solubilization technology that dramatically improved its safety profile. Alfaxalone provides rapid, smooth induction of anesthesia with excellent cardiovascular stability, making it a valuable option for a wide range of canine patients including those with cardiovascular compromise who might not tolerate other induction agents as well.

The mechanism of action of alfaxalone involves positive allosteric modulation of gamma-aminobutyric acid type A (GABA-A) receptors in the central nervous system. By enhancing the inhibitory effects of GABA, the primary inhibitory neurotransmitter in the brain, alfaxalone produces dose-dependent sedation, hypnosis, and ultimately general anesthesia. At higher concentrations, alfaxalone can directly activate GABA-A receptors even in the absence of GABA, producing profound central nervous system depression. This mechanism is similar to other anesthetic agents including barbiturates and propofol but with a unique pharmacological profile that contributes to alfaxalone's distinctive clinical characteristics. The drug produces unconsciousness, muscle relaxation, and amnesia necessary for anesthetic procedures without significant intrinsic analgesic properties.

Alfaxalone is available as a sterile injectable solution containing 10 milligrams per milliliter, formulated with 2-hydroxypropyl-beta-cyclodextrin as a solubilizing agent. This cyclodextrin formulation replaced earlier cremophor-based alfaxalone products that were associated with histamine release and anaphylactoid reactions. The current formulation is well-tolerated with minimal histamine release, allowing safe use in dogs including those with allergic tendencies. Alfaxalone can be administered intravenously for rapid induction or intramuscularly when intravenous access is challenging, though the intramuscular route requires higher doses and produces longer onset times. The drug is also suitable for continuous intravenous infusion to maintain anesthesia for procedures of moderate duration.

The safety profile of alfaxalone in dogs is excellent when used according to labeled instructions with appropriate monitoring. The drug produces predictable dose-dependent effects that are readily titratable, with a relatively wide margin of safety compared to some other injectable anesthetics. Cardiovascular stability is a particular advantage of alfaxalone, with minimal effects on heart rate, cardiac output, and blood pressure at clinically relevant doses. However, like all anesthetic agents, alfaxalone produces dose-dependent respiratory depression and requires appropriate monitoring and the ability to provide ventilatory support. Veterinary supervision is essential for all alfaxalone use, and the drug should only be administered by trained personnel in facilities equipped to monitor anesthetized patients and manage potential complications.

The primary indication for alfaxalone in dogs is the induction of general anesthesia before transition to inhalant anesthetics for surgical procedures. Alfaxalone provides smooth, rapid induction with minimal excitement, allowing quick transition from consciousness to a plane of anesthesia suitable for endotracheal intubation. The drug's cardiovascular stability makes it particularly valuable for induction in patients with cardiac disease, geriatric patients, and other high-risk cases where hemodynamic stability during the transition to general anesthesia is critical. Following induction with alfaxalone, anesthesia is typically maintained with inhalant agents such as isoflurane or sevoflurane, though alfaxalone infusions can maintain anesthesia for procedures of short to moderate duration.

Total intravenous anesthesia using alfaxalone as both the induction and maintenance agent represents an important application of this drug, particularly for procedures where inhalant anesthesia is impractical or contraindicated. Brief diagnostic procedures, minor surgical interventions, and imaging studies requiring immobility but not extended anesthesia are well-suited to alfaxalone total intravenous anesthesia protocols. The drug's rapid redistribution and metabolism allow relatively quick recovery following bolus administration or discontinuation of infusions, returning patients to consciousness in a predictable timeframe. This approach is also valuable when inhalant anesthesia equipment is unavailable, such as in field conditions or during certain specialty procedures.

Cesarean section deliveries represent a specific application where alfaxalone's pharmacological profile offers distinct advantages. The drug crosses the placenta, but puppies born from dams induced with alfaxalone typically demonstrate rapid recovery and good neonatal vigor compared to some other induction agents. The cardiovascular stability of alfaxalone helps maintain maternal blood pressure and placental perfusion during the critical period before puppy delivery. Following delivery of all puppies, the dam can be transitioned to inhalant maintenance for uterine closure and recovery, or alfaxalone infusion can continue depending on the expected procedure duration and clinician preference.

Sedation for minor procedures and diagnostic manipulations can be achieved with lower doses of alfaxalone that produce heavy sedation or light anesthesia rather than surgical planes of unconsciousness. This application is useful for procedures such as wound management, bandage changes, radiography, or ultrasound examination in patients who cannot be adequately restrained with lighter sedation protocols. The rapid onset and relatively short duration of effect make alfaxalone convenient for these brief interventions, with patients recovering quickly once the procedure is complete. Intramuscular administration may be appropriate when intravenous access would be more stressful to establish than the sedation benefits would justify.

Patients with cardiovascular disease benefit particularly from alfaxalone's hemodynamic stability during anesthesia induction. Dogs with dilated cardiomyopathy, degenerative valve disease, congenital heart defects, or arrhythmias may experience dangerous cardiovascular decompensation during induction with agents that produce more significant cardiovascular depression. Alfaxalone's minimal effects on cardiac contractility, heart rate, and vascular tone at clinically relevant doses make it a preferred induction agent for cardiac patients, though careful dose titration and comprehensive cardiovascular monitoring remain essential even with this relatively cardiovascularly-sparing agent.

Alfaxalone dosing in dogs varies based on the route of administration, concurrent medications, and the desired depth of sedation or anesthesia. For intravenous induction of anesthesia, the recommended dose range is 1 to 3 milligrams per kilogram of body weight, administered slowly over at least 60 seconds. The dose should be titrated to effect, with the lower end of the dosing range often sufficient in premedicated patients and higher doses potentially required in healthy, unpremedicated dogs. Rapid intravenous injection should be avoided as it can produce transient apnea and excessive cardiovascular depression. Titrating the dose allows the clinician to achieve the desired plane of anesthesia while minimizing drug administration and associated side effects.

Intramuscular administration of alfaxalone provides an alternative when intravenous access is difficult or would cause excessive patient stress. The intramuscular dose range is 5 to 10 milligrams per kilogram, substantially higher than the intravenous dose due to the slower absorption and first-pass metabolism associated with this route. Onset of sedation or anesthesia following intramuscular injection typically occurs within 5 to 15 minutes, considerably longer than the near-immediate onset following intravenous administration. This route is useful for fractious patients, feral or unsocialized dogs, and situations where pre-induction catheter placement is impractical, though intravenous access should be established once the patient is adequately sedated.

Maintenance of anesthesia with alfaxalone infusion requires continuous intravenous administration at rates of approximately 7 to 10 milligrams per kilogram per hour, adjusted based on clinical assessment of anesthetic depth. Higher rates may be necessary during periods of surgical stimulation, while lower rates may suffice during minimal stimulation. Infusion pumps provide the most accurate delivery, though manual bolus supplementation can maintain anesthesia for brief procedures when infusion pumps are unavailable. The total duration of alfaxalone infusion should be considered, as prolonged administration results in accumulation and extended recovery times compared to brief procedures.

Premedication with sedatives and analgesics significantly reduces alfaxalone requirements for both induction and maintenance. Dogs premedicated with opioids, alpha-2 agonists, or benzodiazepines typically require doses at the lower end of the recommended range and demonstrate smoother induction with less excitement. The specific premedication protocol influences alfaxalone requirements, with alpha-2 agonists producing the most dramatic dose reduction while opioids provide analgesia that improves overall anesthetic quality. Unpremedicated dogs may require doses at the higher end of the range and may show more excitement during induction, though alfaxalone generally produces smooth induction even without premedication.

Recovery from alfaxalone anesthesia depends on the total dose administered and the duration of drug administration. Following a single induction bolus, initial signs of recovery typically appear within 10 to 15 minutes, with full recovery occurring within 30 to 60 minutes in most patients. Prolonged infusions or repeated bolus doses result in drug accumulation and extended recovery times. Recovery quality is generally excellent, with smooth emergence and minimal excitement or dysphoria. However, dogs should be monitored throughout recovery, with attention to maintaining a patent airway until swallowing reflexes return and positioning to prevent injury until coordination is fully restored.

Contraindications to dose adjustments and special dosing considerations apply in certain patient populations. Geriatric patients, those with hepatic dysfunction, and compromised patients may require dose reduction due to altered drug distribution and metabolism. Conversely, young healthy patients and those not receiving premedication may require doses at the higher end of the range. Accurate patient weight is essential for appropriate dose calculation, particularly in small patients where even modest dosing errors represent significant percentage deviations from the intended dose. The attending veterinarian determines the appropriate dose based on comprehensive patient assessment and adjusts based on clinical response during administration.

Alfaxalone produces predictable dose-dependent side effects that, while generally manageable, require awareness and appropriate monitoring. The most significant expected effect is respiratory depression, which occurs in a dose-dependent fashion and may require ventilatory support to maintain adequate oxygenation and carbon dioxide elimination. Apnea commonly occurs with rapid intravenous administration or at higher doses, emphasizing the importance of slow injection titrated to effect and immediate availability of supplemental oxygen and positive pressure ventilation capability. Monitoring with pulse oximetry and capnography allows early detection of respiratory compromise and guides intervention.

Cardiovascular effects of alfaxalone are generally mild compared to other injectable anesthetic agents, which represents one of the drug's primary clinical advantages. At clinical doses, most dogs maintain stable heart rate, blood pressure, and cardiac output, though dose-dependent cardiovascular depression can occur, particularly with rapid administration or higher doses. Some patients may experience mild hypotension that responds to conservative fluid therapy and reduction of anesthetic depth. Bradycardia is less common with alfaxalone than with some other induction agents, though pre-existing bradycardia should be addressed before induction and heart rate monitored throughout anesthesia.

Paddling movements, muscle twitching, and mild opisthotonus may be observed during induction or recovery from alfaxalone anesthesia. These movements do not represent seizure activity but rather reflect the drug's effects on motor pathways during transitions between consciousness states. These effects are typically self-limiting and require no treatment beyond ensuring patient safety during the episode. Dogs should be positioned to prevent injury during these movements, particularly during recovery when the patient may attempt to stand before coordination has fully returned. Reducing the rate of intravenous injection during induction may decrease the incidence of these effects.

Transient excitement or vocalization during induction may occur in some patients, particularly those that are anxious, painful, or not adequately premedicated. While alfaxalone generally produces smooth induction, individual patient variation exists, and some dogs may show brief excitement during the transition to unconsciousness. Appropriate premedication, slow injection, and a calm environment minimize these effects. Excitement during recovery is uncommon with alfaxalone compared to some other anesthetic agents, contributing to its reputation for high-quality recoveries, though individual patients may occasionally show dysphoria or disorientation during emergence that typically resolves without intervention.

Other reported side effects include hypersalivation, nausea, and vomiting, though these effects appear less common with alfaxalone than with some other anesthetic agents. Post-anesthetic nausea can be addressed with antiemetic medications when indicated. Prolonged recovery may occur following extended infusions or repeated dosing due to drug accumulation. Hypothermia commonly develops during alfaxalone anesthesia as with all general anesthetics, requiring active warming measures and temperature monitoring. Rare adverse events including anaphylactic reactions have been reported but appear extremely uncommon with the current cyclodextrin-based formulation compared to older cremophor-based products.

Known hypersensitivity to alfaxalone or any component of the formulation represents the primary absolute contraindication to use. While the current cyclodextrin-based alfaxalone formulation has a much lower incidence of hypersensitivity reactions than older formulations, anaphylactic reactions remain possible in sensitized individuals. Dogs with a history of adverse reactions to previous alfaxalone administration should not receive the drug again, and alternative anesthetic protocols should be developed. Any dog exhibiting signs of hypersensitivity during alfaxalone administration, including urticaria, facial swelling, hypotension, or bronchospasm, should receive immediate supportive care and the drug should be discontinued.

Severe hepatic dysfunction represents a relative contraindication to alfaxalone use due to the drug's hepatic metabolism. Dogs with significantly impaired liver function may experience prolonged drug effect, delayed recovery, and potentially enhanced adverse effects due to reduced metabolic clearance. While mild to moderate hepatic compromise may be manageable with dose reduction and enhanced monitoring, severe hepatic failure may warrant selection of alternative anesthetic agents with less hepatic-dependent elimination. Comprehensive liver function assessment through blood chemistry and evaluation of coagulation parameters should precede alfaxalone administration in patients with known or suspected liver disease.

Alfaxalone should not be used in patients with uncontrolled status epilepticus or those experiencing active seizure activity, as the drug may complicate neurological assessment and monitoring. However, alfaxalone does not lower seizure threshold and is not contraindicated in patients with a history of seizures who are not currently experiencing seizure activity. In fact, alfaxalone's GABA-A receptor modulating activity may provide anticonvulsant effects. Dogs with intracranial pathology including brain tumors, encephalitis, or elevated intracranial pressure require careful consideration of anesthetic approach, though alfaxalone may be appropriate with proper neurological monitoring and avoidance of techniques that further elevate intracranial pressure.

Pregnancy is not an absolute contraindication to alfaxalone, as the drug is commonly used for cesarean section deliveries and appears to provide acceptable neonatal outcomes. However, elective procedures in pregnant dogs should be postponed when possible, and essential procedures require careful attention to maternal oxygenation and blood pressure to protect fetal wellbeing. Alfaxalone crosses the placenta and can produce transient respiratory and central nervous system depression in neonates, though recovery is typically rapid. Neonatal resuscitation equipment and trained personnel should be immediately available when alfaxalone is used in periparturient patients. Additionally, the safety of alfaxalone in breeding dogs, specifically regarding effects on fertility, has not been established, and this should be considered when planning anesthesia for valuable breeding animals.

Drug interactions with alfaxalone are clinically important considerations that influence dosing, monitoring, and protocol selection for canine anesthesia. The most significant interactions involve other central nervous system depressant medications, which produce additive effects with alfaxalone and reduce the dose required for induction and maintenance of anesthesia. Opioid analgesics including morphine, hydromorphone, fentanyl, methadone, and buprenorphine reduce alfaxalone requirements while providing the analgesic component essential for surgical anesthesia. Dogs premedicated with opioids typically require alfaxalone doses at the lower end of the recommended range and demonstrate smoother induction with less excitement.

Alpha-2 adrenergic agonists including dexmedetomidine and medetomidine produce profound sedation that dramatically reduces alfaxalone requirements, often by 50 percent or more. This combination is useful for providing excellent sedation and reducing total drug doses, but requires careful monitoring of cardiovascular effects including initial hypertension, bradycardia, and reduced cardiac output that characterize alpha-2 agonist use. Dogs receiving alpha-2 premedication before alfaxalone induction should receive doses at the lowest end of the recommended range with careful titration to effect. Benzodiazepines including midazolam and diazepam provide anxiolysis and muscle relaxation that complement alfaxalone anesthesia and allow modest dose reduction.

Concurrent administration of other anesthetic or sedative agents requires careful dose adjustment to prevent excessive central nervous system depression. Propofol and alfaxalone should not be mixed in the same syringe but can be used sequentially with appropriate dose reduction. Ketamine can be combined with alfaxalone in balanced protocols, providing additional analgesia and reducing individual drug requirements. Inhalant anesthetics used for maintenance following alfaxalone induction produce additive central nervous system depression, and the transition from injectable to inhalant anesthesia should be managed carefully to prevent excessively deep anesthesia during the equilibration period.

Medications that inhibit or induce hepatic enzymes may alter alfaxalone metabolism and duration of effect. Strong cytochrome P450 inhibitors could theoretically prolong alfaxalone effect through reduced hepatic clearance, while enzyme inducers might accelerate metabolism and shorten duration. Clinically significant interactions from these mechanisms appear uncommon at typical alfaxalone dosing durations, but patients receiving medications known to affect hepatic drug metabolism should be monitored for altered response to alfaxalone. Similarly, concurrent hepatotoxic medications or pre-existing liver disease may impair alfaxalone metabolism and warrant dose reduction. Dogs receiving anticonvulsant medications that induce hepatic enzymes may require higher alfaxalone doses, though this interaction is not well-characterized and individual patient response should guide dosing.

Alfaxalone administration requires adherence to fundamental precautionary measures that ensure patient safety throughout the anesthetic period. The essential precaution underlying all alfaxalone use is the absolute requirement for trained personnel, appropriate monitoring equipment, and immediate availability of resuscitation capabilities. General anesthesia with alfaxalone should never be attempted without proper training in anesthetic monitoring, airway management, and emergency response. Continuous monitoring of heart rate, respiratory rate, oxygen saturation, and anesthetic depth is essential from administration through complete recovery. The ability to provide supplemental oxygen, positive pressure ventilation, and cardiovascular support must be immediately available.

Slow intravenous injection over at least 60 seconds is a critical technique precaution that significantly reduces the risk of adverse effects. Rapid injection can produce transient apnea requiring immediate ventilatory support and may cause excessive cardiovascular depression or exaggerated movement responses during induction. Titrating the dose to effect while injecting slowly allows the clinician to achieve the desired anesthetic depth while minimizing total drug administration and associated side effects. This approach is particularly important in compromised patients, geriatric dogs, and those with cardiovascular disease.

Pre-anesthetic patient evaluation is essential for identifying risk factors and developing appropriate protocols. Complete physical examination, medical history review, and diagnostic testing including minimum database blood work help identify patients at increased risk for anesthetic complications. Patients with known cardiovascular, hepatic, renal, or neurological disease require modified protocols and enhanced monitoring. Appropriate fasting reduces regurgitation and aspiration risk, with most adult dogs fasted for 8 to 12 hours before anesthesia. Small breeds and puppies may require shorter fasting periods to prevent hypoglycemia, and specific fasting instructions should be provided based on individual patient characteristics.

Specific patient populations require enhanced precautions during alfaxalone anesthesia. Brachycephalic breeds require careful airway assessment and management due to anatomical abnormalities that complicate intubation and recovery. Geriatric patients and those with chronic disease may require dose reduction and enhanced monitoring due to altered drug handling and reduced physiological reserve. Pediatric patients require attention to preventing hypoglycemia and hypothermia while ensuring appropriate equipment sizing. Sighthound breeds may show altered drug kinetics related to their unique body composition, though alfaxalone appears well-tolerated in these breeds.

Post-anesthetic monitoring must continue until the patient has fully recovered protective reflexes, coordination, and normal mentation. Dogs recovering from alfaxalone anesthesia should be maintained in a calm, quiet environment with appropriate thermal support. Endotracheal tubes should remain in place until active swallowing reflexes return. Patients should be positioned to prevent aspiration if regurgitation occurs and observed for respiratory adequacy throughout the recovery period. While alfaxalone typically produces smooth, uneventful recoveries, individual patients may experience transient excitement or incoordination that requires intervention to prevent injury. Analgesic and sedative support should be provided as needed to ensure patient comfort during recovery.

Alfaxalone requires specific storage conditions to maintain drug stability, sterility, and clinical efficacy. The drug should be stored at controlled room temperature between 20 and 25 degrees Celsius (68 to 77 degrees Fahrenheit), protected from light exposure, and maintained under normal storage conditions without refrigeration or freezing. Alfaxalone vials should be stored in their original carton until use to protect from light degradation. The storage area should be secure to prevent unauthorized access, as alfaxalone is a Schedule IV controlled substance in the United States requiring documentation and accountability procedures consistent with controlled substance regulations.

Once a vial of alfaxalone is entered, maintaining sterility becomes a critical handling consideration. Multi-dose vials should be used according to manufacturer guidelines for in-use storage, typically no longer than 28 days after initial puncture when stored under appropriate conditions and accessed using aseptic technique. Single-use vials should be discarded after single patient use, with unused portions disposed of appropriately. Strict aseptic technique during vial access and withdrawal prevents contamination that could compromise patient safety. Visual inspection of the solution before each use helps identify contamination, precipitation, or discoloration that would indicate the product should not be used.

Disposal of alfaxalone must comply with controlled substance regulations as well as standard pharmaceutical waste disposal requirements. Unused alfaxalone, expired product, and partially used vials must be disposed of through methods approved for controlled substance destruction, typically involving witnessed destruction and documentation or return to reverse distributors authorized to handle controlled substances. Standard pharmaceutical waste disposal methods are insufficient for controlled substances due to regulatory requirements for accountability. Detailed records of alfaxalone receipt, use, and disposal must be maintained as required by DEA regulations and state pharmacy boards. Veterinary facilities should have established controlled substance management protocols that address all aspects of alfaxalone handling, from receipt through final disposal, with appropriate documentation at each step to maintain regulatory compliance and prevent diversion.

Alfaxalone is generally well-tolerated across all dog breeds when administered appropriately with proper monitoring, though certain breed-specific factors merit consideration during anesthetic planning. Brachycephalic breeds including English Bulldogs, French Bulldogs, Pugs, Boston Terriers, and Pekingese require careful attention to airway management rather than any specific sensitivity to alfaxalone itself. These breeds' anatomical airway abnormalities complicate intubation and recovery from any general anesthetic. Alfaxalone's smooth induction characteristics may actually benefit these patients by reducing excitement and struggling during induction, but experienced personnel and careful airway management remain essential throughout the anesthetic period and during recovery.

Sighthound breeds including Greyhounds, Whippets, Italian Greyhounds, Salukis, Borzoi, and Afghan Hounds have unique physiological characteristics that influence anesthetic management, though specific studies evaluating alfaxalone in sighthounds are limited. These breeds have lower body fat percentages affecting drug distribution and potentially altering elimination kinetics of lipophilic drugs. However, alfaxalone is formulated in an aqueous vehicle and demonstrates water-soluble distribution characteristics that may differ from highly lipophilic agents. Clinical experience suggests that sighthounds tolerate alfaxalone well, though individual variation exists and standard precautions regarding dose titration and monitoring apply.

Giant breeds including Great Danes, Irish Wolfhounds, Newfoundlands, Saint Bernards, and mastiff-type breeds present practical considerations related to drug volume rather than breed-specific sensitivity. Alfaxalone concentration of 10 milligrams per milliliter means that large dogs require substantial volumes for induction, which may be economically significant and require multiple vials for a single procedure. Accurate weight measurement is essential for appropriate dose calculation, and these patients should be monitored for cardiovascular conditions including dilated cardiomyopathy that may be more prevalent in certain giant breeds. Alfaxalone's cardiovascular stability makes it an appropriate choice for giant breed patients with cardiac concerns.

Toy and miniature breeds require precise dose calculation and careful administration technique due to their small body size and limited physiological reserve. The alfaxalone concentration allows accurate dosing even in very small patients, with volumes as small as 0.1 to 0.2 milliliters representing appropriate doses for the smallest toy breeds. Accurate scales, appropriate syringes, and careful dilution technique when indicated ensure precise dosing in these small patients. Small body mass results in rapid heat loss during anesthesia, requiring aggressive warming measures. While toy breeds do not have specific sensitivity to alfaxalone, their limited cardiovascular and respiratory reserves mean that drug effects may be less well-tolerated than in larger patients, emphasizing the importance of careful titration and vigilant monitoring.

Propofol represents the most direct alternative to alfaxalone as an intravenous induction agent for canine anesthesia. Both drugs act on GABA-A receptors and produce similar clinical effects including rapid, smooth induction and recovery. Propofol may produce slightly more cardiovascular depression than alfaxalone, making alfaxalone potentially preferable for cardiac patients, though individual variation exists. Propofol offers the advantage of being uncontrolled, simplifying inventory management and documentation requirements compared to alfaxalone's Schedule IV status. Both agents are suitable for continuous infusion maintenance, though alfaxalone may produce somewhat longer recovery following extended infusions due to accumulation.

Ketamine provides a mechanistically distinct injectable anesthetic option that produces dissociative anesthesia through NMDA receptor antagonism rather than GABA-A modulation. Ketamine is typically combined with benzodiazepines or alpha-2 agonists to counteract muscle rigidity and improve anesthetic quality. The drug offers excellent analgesia, which alfaxalone lacks, making ketamine-based protocols valuable for painful procedures. Ketamine maintains or increases sympathetic tone, producing cardiovascular effects opposite to most other injectable anesthetics, which can be advantageous in compromised patients but requires caution in those with cardiac disease. Ketamine can be administered intramuscularly for initial sedation before establishing intravenous access.

Etomidate serves as an alternative induction agent with exceptional cardiovascular stability, making it valuable for critically ill patients requiring emergency procedures. Etomidate produces minimal cardiovascular depression even in compromised patients, though it causes more injection site pain, muscle rigidity, and myoclonus than alfaxalone. The drug also suppresses adrenocortical function, which limits its use for continuous infusion or repeated dosing. Alfaxalone and etomidate represent the two induction agents with the best cardiovascular stability profiles, with agent selection depending on specific patient needs, concurrent medications, and clinician preference. Veterinary professionals should be familiar with multiple induction agent options to select the most appropriate drug for each individual patient, always emphasizing safety and appropriate monitoring regardless of the specific agent chosen.