Safety of Anesthesia
In this image, the patient has a dedicated anesthetist watching him/her at all times as well as monitoring all of the vitals with appropriate equipment. Meanwhile, a hygienist works on the mouth while the surgeon prepares.
Many dog and cat owners are extremely concerned when their furry family member has to undergo anesthesia. While there are inherent risks of anesthesia, more often than not, the benefits of properly treating dental disease far outweigh the risks of anesthesia.
There are two major things to consider when thinking about anesthetic safety:
1- The general health of the patient. Appropriate examinations and tests should be performed prior to an anesthetic episode. Knowing about the general health of the patient allows for proper anesthetic protocols to be determined. For younger, healthier patients, pre-operative testing is often limited to a general physical examination and blood tests (CBC and Chemistry panel). For older patients or those with pre-existing conditions, a urinalysis and thyroid screening might be appropriate as well. Additionally, for geriatric patients or those with heart conditions, an echocardiogram and/or chest x-rays are often required. Performing these tests does not guarantee a successful outcome with anesthesia, but they do allow the practitioner to make the best decisions for the dog or cat and to properly handle any post-operative complications that might arise. It is important to know that older age does not equate to disease and does not make anesthesia more dangerous. All animals age differently and we commonly perform anesthesia on geriatric patients that are deemed healthy by appropriate pre-operative testing.
2- The knowledge, skill, and caring of those individuals monitoring and delivering the anesthesia. This is of utmost importance for anesthetic safety. All patients undergoing anesthesia should have a dedicated licensed professional administering the anesthesia and monitoring it at all times.
a. Proper monitoring includes all of the below:
i. Oxygenation status (pulse-ox)
ii. Carbon dioxide (CO2)
vi. Blood pressure
What Does General Anesthesia Entail and Who Performs This at ADOS?
Our anesthetic process and protocols are tailored for each individual patient. Below is a list of the stages of anesthesia.
- 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);
- (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.)
- Lubrication of the eyes with an artificial tear ointment. This is important to decrease the risk of a patient developing a corneal ulcers;
- Administering oxygen and anesthetic gas;
- The use of a mechanical anesthetic ventilator. Anesthetic ventilators are 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. Anesthesia and patient monitoring is performed by one of our dedicated Licensed Veterinary Technicians (LVTs) who is constantly involved with the patient’s safety before, during and after the procedure. This person is 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. Numerous parameters are monitored including blood pressure, heart rate, ECG, respiratory rate, pulse rate/quality, blood oxygen saturation level, carbon dioxide (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.
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.
Pre-operative blood tests are 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. If the pre-operative blood tests indicate significant abnormalities, further diagnostic work-up may be necessary prior to anesthesia.
With regards to heart disease, 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 a non-specific indicator of heart disease. For the management of anesthetic risks, we may require that patients with heart murmurs are evaluated by a cardiologist prior to scheduling a dental procedure. Unless there are severe underlying health problems, anesthetic risks associated with heart murmurs are usually manageable. The benefits of treating the oral/dental problem often outweigh the anesthetic risks.