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The Ins and Outs of Anesthesia: What Every Client Needs to Know
February 7, 2012

We understand that many pet owners are nervous about their pet undergoing an anesthetic procedure. Many have had bad experiences in the past, or are concerned because of their pet’s health or age. This article is meant to address the risks associated with anesthesia and help to alleviate any anxiety you may have about your pet’s procedure. We never take any anesthetic event lightly, and hope you will trust your pet in our care. If you have any specific concerns that are not addressed here, please let us know.

What is anesthesia?

Anesthesia is the use of medications to provide a safe means of accomplishing clinical procedures with minimal or no pain, discomfort, or stress to the patient. No two anesthetic events are the same. Anesthesia and sedation protocols should always be tailored to your specific pet’s health status as well as the procedure to be done. A dental prophylaxis on a healthy cat might require vastly different protocols than a spleen removal on a senior-aged dog. Although this handout will briefly discuss the different types of anesthesia, the main purpose is to provide a more comprehensive picture of our process for “general anesthesia.”

There are different categories of anesthesia listed below. Different drugs or drug combinations can be used to achieve each of these levels, and we may utilize multiple levels concurrently. For example, for a joint tap we would use a heavy sedation as well as a local anesthetic to achieve the most effective result. Prior to anesthesia, a thorough physical exam and blood work will also help us establish which medications are appropriate for each circumstance.

• Local Anesthetic – A drug used only in a small area or region (locally) to minimize pain and sensation in that area. A “local” does not have an effect on physical or mental state.
• Sedation– Administration of a drug or drugs which reduces anxiety, stress, irritability, or excitement. Pain medications may be used in conjunction if the procedure might elicit any pain in the patient.
  • Light Sedation - The pet is awake and aware of their surroundings.
  • Heavy Sedation – The pet’s mental state resembles sleep that is not easily disturbed by stimuli.
• General Anesthesia – Administration of drugs that result in a sedated state, followed by administration of an inhalant drug to maintain an unconscious state. This form of anesthesia requires placement of a tube into the airway for continued administration of the inhalant anesthetic gas and oxygen as well as for safety to ensure a clear, functional airway for breathing.

What are the risks of anesthesia?

It is true that there are always risks associated with any anesthetic procedure. The key is how an anesthetist mitigates those risks in each individual patient, as well as how problems are managed if they occur. In order to reduce your own anxiety about your pet’s procedure, it is important to know how we go about mitigating and managing the risks. As mentioned above, the use of any anesthetic or sedative drugs should be tailored to your pet’s individual health needs as well as to the procedure at hand. Because all medications have to be metabolized and cleared by your pet’s body, we pay very close attention to assess your pet’s overall health in order to determine risk factors. Although age is something we take into consideration, older age does not necessarily mean increased risk. There may be increased anesthetic risk in pets who have compromise in a major organ such as the heart, liver or kidneys.

Increased risk does not mean that anesthesia cannot be performed safely on your pet; it means that we may need to utilize extra preventative measures, supportive medications, or special monitoring equipment. Below we discuss some of the steps we take to determine and address these risks.

• Thorough history & physical examination – Your pet will be examined from nose to toes at all visits with your veterinarian. This includes obtaining a thorough history and knowledge of all current medications and supplements, and listening to the heart and lungs to assess for any abnormalities or concerns.
• Pre-anesthetic blood work – This is a crucial step to ensure your pet’s body can metabolize and process any drugs we use. Anytime anesthesia or sedation is considered, it is important that your pet’s blood values be checked. Typical blood work includes CBC (measures red and white blood cells and platelets), and a chemistry panel (measures function of important organs such as the liver and kidneys). Abnormalities on blood work may or may not affect the decision to perform anesthesia, depending on the abnormality.
• Intravenous (IV) catheter – We place an IV catheter (usually in the vein of a front leg) in all general anesthesia cases so that we have quick and direct access to a vein. This allows us to administer anesthetic medications, reversal agents (which can eliminate the effects of drugs previously given), IV fluids, and supportive drugs to your pet efficiently. An IV catheter is crucial to have in an emergency to administer life-saving drugs.
• Intravenous (IV) fluids – Many anesthetic agents can cause dilation (expansion) of veins, which can result in a decrease in blood pressure. We administer IV fluids through the IV catheter to help maintain a normal blood pressure, protecting your pet’s kidneys and other major organs from harm due to prolonged low blood pressure.

One important risk of anesthesia is the drugs themselves. To achieve a sedated or unconscious state, we use medications that can affect blood pressure, heart rate and function, respiratory rate, and temperature. There are not, and should never be, any “one drug fits all” anesthesia protocols. Anesthesia is always safest and most effective when using a multi-modal approach, meaning that different types of drugs are combined to achieve an overall effect. If just one type of drug is used, the anesthetist has to give higher doses of that drug in order to achieve the desired effect, increasing your pet’s risk of experiencing drug side effects (such as low blood pressure, slow heart rate, etc). When multiple types of drugs are used, minimal amounts of each can be used to achieve the sedated or unconscious state, drastically reducing the risk of drug side effects. In addition, some drugs are actually more effective when used in conjunction with other drugs.

Anesthesia monitoring

At Peak there is a certified veterinary technician dedicated to monitoring your pet throughout the anesthesia and recovery period. Your pet’s technician has special training in anesthesia and experience with routine as well as high-risk patients and procedures. The anesthesia technician does not leave your pet’s side and continually monitors and records the heart rate and rhythm (EKG), respiratory rate, temperature, blood pressure, and pulse oximetry (oxygen concentration). In addition, the anesthetist monitors your pet’s level of anesthetic depth and makes adjustments according to their needs.

Pain management

We practice preventative pain management. This means that when pain is expected during or as a result of a procedure, we start pain control agents prior to the procedure. This can block the pain’s transmission pathway thereby preventing the pain from occurring during the stimulus. This allows for greater control of pain following a painful event or procedure.

Preparing for your pet's anesthetic procedure

You will be asked to withhold food for 12 hours prior to procedure time. You may leave water available until admission at the hospital. If your pet is diabetic or is prone to low blood sugar, please call for instructions on fasting and insulin dosing. If your pet is on any medications or supplements, please call to ask if they should be given or withheld the day of the procedure. Make sure your veterinarian knows the complete list of medications and supplements your pet is taking, as some drugs can interfere with others. Normal routines, including exercise, can be continued before a procedure unless otherwise directed.

What does my pet experience?

It is our constant goal to be aware of your pet’s potential stress level, watching for behaviors or body language cues that may indicate anxiety. We work slowly and gently to alleviate any anxiety your pet may experience by being in the hospital. We schedule ourselves lightly (only one or two procedures per day) so that we can take the time to get to know your pet and give them lots of love before, during, and after a procedure.

The following is a detailed description of the anesthetic process from beginning to end. When admitted for a procedure, your pet will accompany a technician into our treatment room where both the doctor and technician will complete a physical exam. Blood work will be performed if it hasn’t been already. Once these steps are complete, a drug protocol will be chosen based on results and findings.

Your pet will be given medications to help them relax as well as to begin the pain management process. After this has had time to take effect, an IV catheter is placed. At this point we move forward with “anesthesia induction.” This means that additional drugs are administered resulting in a heavy sedation. This allows for the placement of a tube into the airway (endotracheal tube) and administration of oxygen and inhalant anesthetic gas. Monitoring equipment is attached and the technician monitors, records, evaluates, and makes adjustments for the duration of the procedure. They are provided with safe heat sources to help them maintain their body temperature. At the end of the procedure, the technician discontinues the inhalant gas but continues the oxygen and monitoring as your pet begins to wake up. Once your pet has wakened enough to regain their swallowing reflex, the endotracheal tube is removed and oxygen supplementation will be discontinued. From this point, your pet will be placed on a soft bed in his or her kennel to continue waking up. A technician will closely monitor your pet during this recovery period to make sure your pet is calm and comfortable and pain is controlled. We will also determine if any drugs need to be added or reversed and will continue monitoring body temperature and providing a warming source if necessary.

We do not often allow owners to visit their pet during the recovery period. Visits usually result in an excited and anxious state, when the goal is to keep your pet quiet and calm.

What can I expect when my pet comes home?

Pets that go home the same day of their anesthetic procedure will usually spend a few hours recovering here in the hospital before being discharged. Our goal is to make sure that your pet has safely recovered and is comfortable and alert before discharge. Though we try to make sure that your pet is fully awake when you pick them up, the result of anesthesia and/or any pain control medications may possibly result in being subdued or slightly uncoordinated up to 24 hours after the procedure. Monitor and use care upon arriving home to make sure they are able to go up and down stairs safely on their own. Your pet’s doctor or technician will go over detailed home care instructions with you, including any medications or special care to be given. We recommend offering a reduced volume of dinner that night. Your pet may be tired from their big day and want to sleep most of the evening. In most cases, by the following day your pet should be back to him or herself.

If your pet has undergone a major procedure and needs to stay overnight, you will receive detailed instructions on home care at the time of discharge.

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