A few weeks ago, I had a client who had a cat with severe dental disease. This client initially declined my strong recommendation for oral surgery because he was afraid of sedating his 14-year-old-cat, Bob. He told me that his friend's cat died under anesthesia and he would not be able to forgive himself if Bob died while having his teeth cleaned.
To convince him to follow my recommendations, I had to educate Bob's father and address his fears. First, I told him that not only is Bob suffering from dental disease that could aggravate his kidneys, liver or heart, but he is also in chronic pain. This pain is adversely affecting his quality of life and will only get worse over time. Second, all anesthetic procedures have risks, but they can be greatly minimized with proper pre-anesthetic workup and careful selection of your anesthetic team. After a lengthy discussion, Bob's father realized the risk of an anesthetic complication was lower than he feared and the value of having oral surgery performed on his best friend was greater than he had thought.
I believe an educated client makes the best health care decision for their pets. I recommend that you ask your veterinarian the following questions to help minimize your pet's anesthetic risks:
- Does your veterinarian require a pre-surgical examination and blood work before surgery? I believe strongly that every pet should receive a thorough physical examination prior to sedation. In addition, a complete blood cell count (CBC) and comprehensive blood chemistry panel should be performed to make sure that there are no hidden medical problems prior to sedation. For instance, if your pet has kidney or liver issues, an adjustment can be made in the anesthetic protocol. Or, if a heart murmur is discovered, a chest radiograph or ultrasound may be recommended.
- How does your veterinarian monitor your pet's vitals during the anesthetic procedure? Anesthesia today is much safer than it was five to 10 years ago. Many years ago, veterinarians would monitor their anesthetized pets by looking at their mucous membranes (gums) and listening to their chest. Today, we have sophisticated monitoring equipment that detects small changes in your pet's blood oxygenation (pulse oximetry), carbon dioxide levels (capnograph), blood pressure, body temperature and electrocardiogram (ECG). Closely monitoring these parameters help prevent small abnormalities from becoming catastrophic event. Make sure your veterinarian has the proper monitoring equipment available for your pet.
- Who monitors the pet when it is under anesthesia? Not only should your veterinarian have the appropriate monitoring equipment, but make sure there are competent people watching it. For instance, at Animal Medical Center of Chicago (AMCOC) a surgical nurse and certified veterinary technician will monitor Bob's vital parameters while the doctor evaluates his pet's teeth and performs oral surgery. My technician can detect subtle changes in Bob's monitored values and make appropriate adjustments before detrimental events occur. For instance, if Bob's blood oxygen level drops slightly, my technician will quickly adjust his anesthetic depth or increase his rate of respiration to circumvent a problem.
- Who calculates and delivers the anesthetic drugs? Every anesthetic patient must be treated as an individual. The anesthetic drugs may initially be calculated based on your pet's weight, but they should be given based on your pet's response to the drug. Most importantly, the person who administers these drugs should be a certified veterinary technician or a veterinarian.
- How does your veterinarian sedate the pet? No dental procedure should be performed without proper sedation. This means all pets are intubated with a tracheal tube and placed on an anesthetic gas machine. In addition, at AMCOC, all anesthetized pets are placed on a mechanical ventilator to ensure your pet breathes regularly and at a proper depth. A proper dental procedure can never be performed on an awake pet.
- Who is with your pet when it wakes up from anesthesia? An anesthetized pet should never be left alone in a cage to recover. During the anesthetic protocol a tracheal tube is inserted down your pet's trachea and is attached to an anesthetic machine so that anesthetic gases can be delivered to your pet's lungs. Only when your pet is alert and swallows should this tube be removed. The likelihood that your pet would aspirate fluids on recovery is virtually eliminated with this protocol. In addition, the recovery nurse is there to respond to your pet's needs, such as pain or anxiety.
Bob was sedated this week and his teeth were cleaned and evaluated. Unfortunately, numerous teeth were surgically extracted but Bob recovered beautifully. Within hours of his anesthetic recovery, Bob was happily eating chicken flavored baby food.
Anesthesia can be scary, but your fears can be minimized with knowledge. Before you sedate your pet for any other surgical procedure, make sure the right people are there with the right monitoring equipment. Please don't sacrifice quality care because you didn't know your veterinarian's anesthetic protocol. Ask your veterinarian how they prepare your pet for his/her anesthetic procedure, who is present, what's monitored and how the pets recovered. Anesthesia needs its proper respect and don't ever let anyone convince you otherwise.
Anesthesia is definitely safe in the right hands and with the proper precautions. If not, it can be very dangerous. In conclusion, know your pets true anesthetic risks and choose your veterinarian and anesthetic team wisely.
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