Your dog (or cat) is scheduled for a surgical or dental procedure and requires anesthesia. You are very concerned, actually maybe a bit worked up about the upcoming event.
This isn’t surprising, as a recent study showed that 50 percent of people who were to undergo general anesthesia themselves were more worried about the anesthesia than the procedure. It is a simple fact that anesthesia can never be completely free of risk. The most recent statistics indicate that anesthesia safety has improved for dogs but death rates hover around 0.05 to 0.2 percent. Additionally, for the dog with significant health problems, such as chronic heart, lung, or kidney disease, there is a slightly increased risk. Finally, these statistics only describe the anesthesia-related risk; surgery-related risk also has to be taken into account.
Most dogs require at least sedation, and, often, general anesthesia, to undergo procedures and surgery since, unlike people, they can’t be calmed easily by nurses holding their paws or by a verbal explanation of what’s going to happen. Whether the benefits of a procedure outweigh the risk is a question that needs to be answered for each dog, and only you can assess the pros and cons of a procedure appropriately in conversation with your veterinarian. So, if anesthesia has some risk and your pet requires it for a procedure, what can be done to reduce this risk and allay your fears?
Understand Your Pet’s Health Status
Because many anesthesia-associated risks are associated with “pre-existing diseases,” you can reduce the risks by keeping your pet healthy. Besides ensuring lean body condition (obese animals have a higher anesthetic risk), providing a quality diet (which, surprisingly, involves variety, including vegetables), and minimizing drug/supplement intake, be sure you schedule regular visits for your pet with your family veterinarian to ascertain “health and wellness.” While it may sound rather simple, the annual exam coupled with an in-depth discussion of your pet’s health is the single most important service your family veterinarian can provide. Palpation of internal organs, examination of mobility, listening to the heart and lungs, and the use of certain diagnostic tools (blood tests, X-rays, ultrasound) are services that “Dr. Google” can’t provide.
Armed with this information, your veterinarian can make better anesthetic drug choices and plan for the safest anesthesia possible for your pet. If your pet already has what we as anesthesiologists call “critical organ problems” (i.e., heart, kidney, airway, lung, or neurologic disease), optimizing your pet’s health before anesthesia and surgery is paramount to a successful outcome. Advances in veterinary anesthesia allow us to regularly anesthetize pets with significant disease, even organ failure, and these patients can do very well. The key to success with the less healthy patient lies in making sure that any pre-existing disease is as well-controlled as possible, especially immediately before and during the procedure. This may involve making a few drug adjustments, or admitting your pet a day or night earlier to receive intravenous fluids, or possibly even doing a few more diagnostic tests. The stronger your pet is before the procedure, the better she will do afterwards.
Communication Is Key
Communication between you and the veterinary team is critical. Follow any advance fasting instructions given to you by the veterinary team for your pet. Arrive with a list of drugs and supplements that your pet is taking. Remind the doctor and technician of prior health and behavior issues, as well as your pet’s regular diet and any recent issues (for example, collapsing, tiredness, coughing, sneezing, vomiting, diarrhea, loss of appetite, excess thirst). Knowing what supplements or regular medications your dog (or cat) is taking, and being advised of any recent changes to their health, will help your veterinarian ensure that the best drug choices and techniques are chosen for anesthesia of your pet. Discuss any previous anesthesia and how it went, any concerns you have, and ask any questions you need to relieve your worry. Some questions you may want to ask include:
• Will a person trained/familiar with managing anesthesia be monitoring my pet? Is this person credentialed, or is s/he trained in anesthesia?
• Surprisingly, most of the anesthesia in veterinary practices is chosen by the doctor but delivered by technicians. Ensuring that all members of the team (doctors and technicians) have anesthesia experience and pursue regular continuing education in this field is very important to your pet’s anesthesia success.
• What machines will be used to monitor safety of the procedure? Objective monitors of heart and lung function, oxygenation, pulse rate, etc., are great tools, but they must be utilized by a well-trained, knowledgeable technician or doctor, who is dedicated to only monitoring your pet during anesthesia.
• What is my pet’s risk? You are essentially asking the doctor to help you weigh the pros and cons of the procedure.
• Does the practice subscribe to one or a few (varied) anesthesia plans? Most modern veterinary practices have at least two to three anesthesia plans with which staff are familiar and that allow individualization of drug choice, route, and dose for the needs of the individual patient.
• What tests should be run before anesthesia to ensure better outcomes from both the procedure and anesthesia itself? Let’s optimize my pet’s chances of anesthesia going well by finding out what’s going wrong internally first and then fixing it.
• Will supplemental oxygen be provided during the procedure? Will my pet be intubated? Oxygen is the first and best antidote for much of the depression of breathing caused by anesthesia and control of the airway can assist with breathing.
• What CPR training has the staff undergone? Should something go awry, will necessary CPR drugs and equipment be readily available?
• How will stress, pain, and inflammation be addressed? Ask if an opioid, an anti-inflammatory, and a local anesthetic will be used as part of the anesthesia. General anesthesia should often include these drugs as part of the protocol for your pet.
• How and where will my pet recover? What will be available for pain relief in the first 24 to 48 hours? How much pain should I expect my pet to experience from this procedure?
Board-certified Veterinary Anesthesiologists
An increasing number of general and specialty referral practices retain the services of board certified veterinary anesthesiologists who are credentialed by the American College of Veterinary Anesthesia and Analgesia. or ACVAA. These specialists are experts in anesthetic management and can minimize risk for your pet because of extensive experience and education in anesthesiology. Similar to what you would experience by having an anesthesiologist for any procedure you may undergo, a veterinary anesthesiologist’s only job is to make sure that your pet is safely anesthetized and that optimal pain relief is provided. A list of board-certified veterinary anesthesiologists, as well as more information about the ACVAA and how to contact an anesthesiologist, can be found at ACVAA.org. Some practices also employ certified, specialty trained anesthesia technicians. If your vet’s practice does not have staff anesthesiologist, veterinarians can confer with these colleagues regarding pre-operative patient stability, drug choices, and intra-operative care. So ask your veterinarian if he has access to a consultation with an ACVAA board-certified anesthesiologist if you feel it might be helpful for safe anesthesia. If you feel your pet’s anesthetic risk may be high, seeking the direct assistance of a board-certified anesthesiologist within your geographic region may be an option.
MYTHS ABOUT ANESTHESIA
Understanding a few misconceptions about veterinary anesthesia can help allay fears.
Myth: Fewer drugs are better.
Truth: The right combination of drugs in the correct doses is often not only necessary for our veterinary patients, but also has been proven safer in the scientific literature than reliance on one drug only.
Myth: Certain anesthetic drugs (e.g., ketamine or isoflurane) are dangerous for my pet.
Truth: A combination of injectable and inhalant anesthetics are normally used to provide for an individualized, balanced anesthetic plan, wherein safety is maintained but excessive anesthetic depth is avoided. It is more important to provide attentive monitoring and supportive care since all anesthetic drugs can potentially have unwanted side effects. Rarely does the particular drug matter as much as how the patient is taken care of before, during, and after anesthesia.
Myth: Pain and stress are obliterated by anesthesia.
Truth: Anesthesia and hospitalization are both very stressful for any pet. While general anesthesia relieves your pet’s perception of pain and stress while it is anesthetized, once it regains consciousness, it will feel pain and experience stress, In almost every instance, an opioid plus a drug that relieves anxiety should be part of every anesthesia protocol. Pain relief and stress reduction prior to anesthesia mean that lower doses of all anesthetic drugs are used, and this minimizes risk for your pet.
Myth: All veterinarians provide the same level of anesthesia care and expertise.
Truth: Anesthesia care can be quite different amongst veterinary hospitals. Some practices are staffed with extensively trained personnel who only deliver anesthesia and can focus solely on keeping your pet safe.
Kris Kruse-Elliott, DVM, PhD, DACVAA, is medical director of AnimalScan in Redwaood City, an MRI facility for pets; is board certified by the American College of Veterinary Anesthesia and Anagelsia; and also submitted this article from the ACVAA.
Main article photo by: Photo courtesy of Dr. Andrea Looney, DACVAA