Anesthesia and Pain Control
Today, general anesthesia for pets is very safe and we routinely anesthetize pets from 2 months to 16 years old and from 1 pound to 200 pounds. As in human anesthesia, the very young, the very old, and the very small are always at highest risk of complications, however, with our modern laboratory testing, and our anesthetic support and monitoring equipment, the risk is very low.
At the Stop 11 Animal Hospital, every patient admitted for any anesthetic procedure undergoes a thorough physical exam to look for evidence of infection or disease which might be affected by anesthesia. We also require that all patients scheduled for an anesthetic procedure have laboratory tests run to evaluate their red and white blood cells, platelets, and liver and kidney function, looking for problems we might miss on the physical exam. The actual chemistry profile run will depend upon the patients age and medical condition, and may include electrolytes, blood clotting tests or additional blood enzyme tests.
As newer anesthetics have come along which are eliminated from the body faster, we have learned that they provide less and less pain control. Therefore, we have become more aggressive with supplemental medications to improve our patient's comfort level. This is one reason that our anesthetic protocol includes a combination of medications, which in addition to providing optimal comfort for the pet, also offers the benefit of lowered risk by utilizing a lower total dose of anesthetic drugs. In general, most patients receive an anti-anxiety/tranquilizer, a narcotic pain medication, an NSAID (Non-Steroidal Anti-Inflammatory Drug) pain medication before administering one or more short acting injectable anesthetic drugs. As soon as the patient is adequately sedated, an endotracheal tube is placed and the pet is connected to an inhalant system that administers a gas anesthetic agent and oxygen. The inhalant system allows us to fine tune the level of anesthesia as needed throughout the procedure to maintain the proper comfort level without using more medication than the pet needs. Most patients undergoing oral or orthopedic surgery will also receive a local anesthetic regional pain block.
As soon as the patient is anesthetized, he or she is connected to our Vetronics VitalScan monitor. The VitalScan monitors blood pressure, ECG (electrocardiograph, also known as EKG in TV lingo), tissue oxygen perfusion (pulse-ox), body temperature, and respiratory rate. The veterinarian and a technical assistant also stay with the patient throughout the procedure and visually monitor the pet in ways that the electronic equipment cannot.
Throughout the anesthetic procedure, our patients are kept comfortable on an insulated pad. Small pets, or pets undergoing prolonged procedures will also be placed on a heated, re-circulating water blanket to help maintain body temperature, and may have an I.V. fluid heater used to further supplement their body temperature, which almost all anesthetics lower.
For all of our patients, we encourage the additional safety precaution of placing and intra-venous catheter and administering fluids during anesthetic procedures. In reality, this is only an option we offer for our young patients undergoing routine procedures when cost needs to be limited. For non-routine procedures, and for older patients, the additional safety net of a ready I.V. access port as well as the improved kidney filtration of anesthetic drugs and improved blood pressure from having "fluids on board" is too important.
As the anesthetic procedure approaches the end, the level of inhalant anesthetic can be turned down, then turned off when the last stitch is placed, or the last tooth polished. The patient stays under close observation and monitoring until the patient is swallowing well, blinking, and starting to move around. At that time, the endotracheal tube is removed, the monitoring equipment is turned off and disconnected. Then the patient is moved to a padded cage or run where he or she continues to be monitored closely until stable standing and ready to go home, generally two to four hours after the procedure.
Depending upon the procedure performed. Many of our patients are sent home with mild narcotic pain medications (Buprenorphine for cats and some very small dogs, Tramadol for larger dogs) and our canine patients are also generally sent home with an NSAID pain medication (Rimadyl, Deramaxx, or Metacam).
We strongly recommend that none of our patients be on any pain medication at home without checking with us first. This is especially critical if we are planning on any surgical procedures, as many human OTC (Over The Counter) NSAID drugs and some "Nutritional Supplements" are blood thinners (especially aspirin), and may also be toxic to the kidneys and liver. Most human OTC NSAID drugs also have the potential to interact, sometimes fatally, with medications in our anesthetic protocol.