Jul 13, 2026 · 18 min · 8 segments
In the July open access episode of Chattering With iCatCare, Yaiza Gómez-Mejías is joined once again by feline specialist Nicki Reed to continue navigating the high-pressure world of feline medical…
When should we suspect an increased intracranial pressure, and how should we be positioning these cats?
They don't do the classic Cushing response of increased blood pressure and slow heart rate.
So really any kind of head trauma patient, for example, a cat who's been seizing for a period of time, you might suspect that it could be there.
And in that situation, you're best to raise the head above the shoulder level of the body.
Although I find it easier just to put the entire cat onto something like a board and raise it at, at an angle of about 20 to 30 degrees to the horizontal.
So you need to make sure that you're not doing that and potentially putting pressure onto the jugular vein, the carotid artery in that area.
Just raise the entire body or at least the body upwards from the shoulder right up to the head.
Whilst all this is happening, if you had to choose between midazolam and diazepam, would you have a preferred choice?
In terms of efficacy, I don't think that there's any evidence that one is better than the other.
I'm always a little bit wary about the possibility of an idiosyncratic reaction to diazepam causing liver failure, and therefore if I have access to midazolam and diazepam, my preference would probably be for intravenous midazolam.
If intravenous access is difficult because the patient is seizing and you're maybe having to think about alternate routes, rectal diazepam is available, and I would use that as an option.
There are some special devices that are available for aerosolizing that, but if you're stuck in practice, you could just use one of the nozzles that's used for kennel cough administration, for example, and use that to spray the midazolam onto the nasal mucosa if you didn't have intravenous access.
I think if you've got toxin access, you can establish whether or not it's one that is appropriate to use intra-lipids for.
If you've got a suspicion of a toxic agent, a perfectly healthy cat that was fine in the morning and went out and may have eaten something, it wouldn't be unreasonable to use it.
I haven't come across any case reports in cats, but it has also been used to address neurological complications of hepatencephalopathy associated with portosystemic shunts.
When should we suspect an increased intracranial pressure, and how should we be positioning these cats?
They don't do the classic Cushing response of increased blood pressure and slow heart rate.
So really any kind of head trauma patient, for example, a cat who's been seizing for a period of time, you might suspect that it could be there.
And in that situation, you're best to raise the head above the shoulder level of the body.
Although I find it easier just to put the entire cat onto something like a board and raise it at, at an angle of about 20 to 30 degrees to the horizontal.
So you need to make sure that you're not doing that and potentially putting pressure onto the jugular vein, the carotid artery in that area.
Just raise the entire body or at least the body upwards from the shoulder right up to the head.
Whilst all this is happening, if you had to choose between midazolam and diazepam, would you have a preferred choice?
In terms of efficacy, I don't think that there's any evidence that one is better than the other.
I'm always a little bit wary about the possibility of an idiosyncratic reaction to diazepam causing liver failure, and therefore if I have access to midazolam and diazepam, my preference would probably be for intravenous midazolam.
If intravenous access is difficult because the patient is seizing and you're maybe having to think about alternate routes, rectal diazepam is available, and I would use that as an option.
There are some special devices that are available for aerosolizing that, but if you're stuck in practice, you could just use one of the nozzles that's used for kennel cough administration, for example, and use that to spray the midazolam onto the nasal mucosa if you didn't have intravenous access.
I think if you've got toxin access, you can establish whether or not it's one that is appropriate to use intra-lipids for.
If you've got a suspicion of a toxic agent, a perfectly healthy cat that was fine in the morning and went out and may have eaten something, it wouldn't be unreasonable to use it.
I haven't come across any case reports in cats, but it has also been used to address neurological complications of hepatencephalopathy associated with portosystemic shunts.
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