What Does General Pet Anesthesia Entail and Who Performs This at ADOS?
Our anesthetic process and protocols are tailored for each individual patient and entail multiple stages. This includes:
- Gathering and evaluating the patient’s medical history and preanesthetic diagnostic lab results;
- Assessing preanesthetic physical and conscious oral exam findings;
- Planning preanesthetic and anesthetic drug and fluid administration protocols;
- Administering preanesthetic drugs (sedative and preemptive pain medications);
- Monitoring the patient until time for anesthesia induction;
- Preparing the patient for intravenous (IV) catheter placement;
- Intravenous anesthetic induction;
- Sterile endotracheal tube placement. (We use new, sterile endotracheal tubes for each patient. We do not “reuse” endotracheal tubes, IV fluids bags or IV tubing.) Virtually all of our patients are intubated, which means that they have a cuffed endotracheal tube placed in their trachea (airway) to allow them to safely breathe in oxygen and a gas anesthetic during the procedure. We ensure that the endotracheal tube’s cuff is inflated sufficiently to prevent aspiration of fluids or bacteria into the lungs during the procedure. To protect the patient’s eyes, they are lubricated with an artificial tear ointment. This is important throughout the procedure to decrease the risk of a patient developing a corneal ulcer as a result of the surface of the eye drying out;
- Administering oxygen and anesthetic gas;
- Hooking patients up to a mechanical anesthetic ventilator. Anesthetic ventilators are not commonly used in most hospitals, however, it is the “standard-of-care” at ADOS, when properly utilized, they are more efficient, accurate and effective in delivering required oxygen and anesthetic gases to the patient. This adds up to being “safer”;
- Attaching all anesthetic monitoring equipment. Our anesthesia and patient monitoring is performed by one of our dedicated Licensed Veterinary Technicians (LVTs) who are constantly involved with the patient’s safety before, during and after the procedure. Our LVTs are dedicated to performing anesthetic patient monitoring. They are focused on this task only and they are not responsible for the dental procedure or other tasks while the patient is under anesthesia. There is a constant dialog between the specialist and the LVT monitoring the patient, so that if anesthetic related issues should arise, they can be recognized and rectified quickly. While your pet is under general anesthesia, the veterinary technicians are checking numerous parameters to ensure their safety. These include Doppler blood pressure, heart rate, ECG, respiratory rate, pulse rate/quality, blood oxygen saturation level, carbon dioxide present in expired gases (capnography), body temperature and depth of anesthesia. If you were given one parameter with which to monitor a patient under general anesthesia, veterinary anesthesiologists would choose capnography (monitoring end-tidal CO2 level.) Capnography requires advanced anesthetic skills and is also utilized in every patient as a “standard-of-care” at ADOS;
- All mechanical monitoring is supplemental to direct patient observation and manual assessment by one of our highly trained and experienced LVT staff members;
- Monitoring the patients continually and closely following the anesthetic period and through the patient’s emergence from general anesthesia (recovery);
- We are “hands on” with our patients until they are completely recovered from the effects of anesthesia.
If we could lay out a typical time frame for the anesthetic process: the preanesthetic period is roughly 30 to 45 minutes; the length of the anesthetic period varies with the procedure, however, this is usually 1 to 2 hours; anesthetic recovery is usually another 1 to 2 hours. Therefore, your pet is under our close observation and care for roughly a total of 2.5 to 5 hours. The hospital space, our education and training and your pet’s care are all included as parts of the anesthetic costs. The board certified dentist is directly in charge of all patient related decision making, oral exams, anesthesia and dental and oral surgical treatments. Although our LVTs are highly trained and skilled individuals, they are under the direct supervision of the specialist at all times.
Pet Anesthetic Safety:
Although there is always some degree of inherent risk, most major anesthetic risks are associated with two things:
- The general health of the patient. (When the appropriate preanesthetic health screening has been performed, the risks associated with the anesthetic management are markedly lower. The same holds true for most of our patients with other existing health related problems.) The more we know the details of your pet’s health, the safer we can deliver anesthesia and effective oral health care;
- The level of training, knowledge, skills and caring of those individuals administering and monitoring the anesthesia itself. This is of utmost importance for anesthetic safety. This arena of care is “behind the curtain”, and is not the same in every veterinary (or human) facility. It’s what goes on behind the scene that counts. ADOS maintains among the highest standards for anesthesia and anesthetic related care. Please refer to the preanesthetic risk assessment page on our website (animaldentalspecialist.com) for information on proper preanesthetic risk assessment and required testing.
ADOS maintains a regular schedule of veterinary anesthesia related continuing education and training (from board certified veterinary anesthesiologists) for our technicians and oral surgeons. Amongst the community of veterinary specialists, ADOS maintains a reputation of excellence for patient care, anesthetic skills and anesthetic safety.
At ADOS, our anesthetic machines and equipment are inspected and serviced by professionals on a regular basis.
Pre-operative blood work assessment is important to obtain prior to anesthesia because there can often be issues with internal organs or systems that are not apparent clinically. It is common for many existing health problems to not have clear signs externally until the disease process has reached a more advanced stage. At the time of the consultation, if recent lab values (including a Complete Blood Count and Biochemistry Profile) are not available, this could be performed within our facility. If a patient happened to have undetected health problems, anesthetic drugs and the general stress of the anesthesia, could have a negative effect on patient homeostasis and the overall safety of the anesthetic/oral procedure event. If the pre-operative blood work indicates significant abnormalities, further diagnostic work-up may be necessary prior to anesthesia. There is always some degree of risk associated with any anesthetic event, however, the more we know about the details of the patient’s health, the better we can anticipate and prevent problems. If complications happen to occur, we are prepared to recognize and treat them. It is important to understand that a patient may have serious heart disease and not have any outward symptoms like a murmur. The presence of a heart murmur is, however, a non-specific indicator of heart disease. For the management of anesthetic risks, we require that all patients with heart murmurs have these evaluated (diagnosed) by a cardiologist prior to scheduling a dental procedure. Unless there are severe underlying health problems, anesthetic risks are usually manageable. The benefits of treating the oral/dental problem usually outweigh the anesthetic risks.
If your pet’s anesthetic risk assessment is manageable, a procedure can be scheduled after your initial consultation appointment. After the consultation/exam, you will be provided with an estimate that includes the low and high ends of the costs associated with the anticipated anesthetic and dental procedures. This will be reviewed in detail with you. After an oral exam has been completed (including intraoral radiographs) under general anesthesia, you will be contacted by phone to discuss the updated exam findings, treatment options and cost estimate. Please view our anesthesia risk classification form.